Intravertebral Vacuum Phenomenon Research Articles

Kyphoplasty for thoracic and lumbar fractures with an intravertebral vacuum phenomenon in ankylosing spondylitis patients.

BackgroundIntravertebral vacuum phenomenon (IVP) is a special sign after vertebral fractures, which is common in patients with ankylosing spondylitis (AS) and may indicate pseudarthrosis and bone nonunion that lead to spinal instability. The objective of this study is to evaluate the efficacy and safety of kyphoplasty (KP) in treating such types of vertebral fractures with AS.MethodsSixteen patients with AS suffering from thoracic or lumbar fractures with IVP received KP from 2015 to 2020 and were monitored for more than 1 year. The visual analog scale (VAS) score was used to evaluate back pain relief. The Oswestry Disability Index (ODI) questionnaire was used to assess the improvement of the patients' living quality. The anterior and middle vertebral height restoration ratio (AVH, MVH) and the kyphotic angle (KA) were used to evaluate the radiographic results.ResultsThe mean follow-up period was 20.8 months (12–28 months). The VAS and ODI significantly reduced at 3 days, 3 months after surgery, and at the last follow-up compared with the preoperative outcomes (p < 0.05). The AVH and MVH were significantly increased compared with the preoperative outcomes (p < 0.05). There was a significant correction in the KA between pre- and postoperative assessments (p < 0.05). Asymptomatic intradiscal polymethylmethacrylate (PMMA) cement leakage was found in two patients.ConclusionsFor thoracic or lumbar fractures with IVP in AS patients, KP may be safe and effective, which achieves pain relief and satisfying functional improvement, restores the anterior and middle height, and corrects the kyphotic angle of the fractured vertebra.

MRI fluid sign is reliable in correlation with osteonecrosis after vertebral fractures: a histopathologic study

Magnetic resonance images (MRI) fluid sign and intravertebral vacuum phenomenon of the plain radiograph are considered as the characteristic radiological findings for vertebral osteonecrosis after spinal fractures. We aim to study the association between the radiological and histopathologic findings of vertebral osteonecrosis through the use of an open retrieval of specimens. Twenty consecutive patients (54-84 years, mean 73 years) of unstable vertebral compression fractures treated with anterior corpectomy and fusion were included. All the images and pathologies were correlated, especially the histopathologic changes to the fluid sign and vacuum phenomenon. MRI fluid signs and the histopathologic findings of vertebral osteonecrosis were significantly correlated and both were noted in the first 5 months after injury. The power of the fluid sign in diagnosing vertebral osteonecrosis was better than that of the intravertebral vacuum phenomenon (diagnostic odds ratio 65 vs. 2, sensitivity 86 vs. 50%, specificity 100 vs. 67%). MRI fluid sign is more predictable to diagnose vertebral osteonecrosis in operative case, especially within the initial 5 months after injury.

Decreases in fluid shear stress due to microcracks: A possible primary pathogenesis of Kümmell’s disease

The German doctor Hermann Kümmell described Kümmell’s disease as the clinical scenario in which patients suffer a trivial spinal trauma, but develop a symptomatic, progressive, angular kyphosis after a symptom-free period of months to years. Since an intravertebral vacuum phenomenon, which is considered indicative of ischemic osteonecrosis, is often seen in the radiographs of patients with Kümmell’s disease, most authors regard ischemic necrosis of the vertebral body as the primary pathogenesis of Kümmell’s disease. However, we argue that Kümmell’s disease is not commonly associated with typical avascular osteonecrosis of the femoral head and the intravertebral vacuum phenomenon is also present in other diseases. We postulated that even if ischemia plays a role in the pathogenesis of Kümmell’s disease, it would not be the proximal cause of Kümmell’s disease. In this article, we review the role of fluid shear stress in bone remolding and propose a microcosmic hypothesis in which microcracks lead to decreased fluid shear stress, which acts as the primary cause of Kümmell’s disease. This was supported by conclusions drawn from a literature review: (1) fluid shear stress plays a crucial role in bone remodeling, and the osteocyte network is the main sensor of this mechanical stimulus; (2) decreased fluid shear stress will cause disequilibration of bone homeostasis, increasing bone resorption and reducing bone formation; and (3) the fluid flow of lacunar–canalicular porosity (PLC) and fluid shear stress near the microcracks decreases.

Endplate degeneration may be the origination of the vacuum phenomenon in intervertebral discs

The intravertebral vacuum phenomenon (VP) is usually associated with degenerative disc disease, which could be related to the low back pain. Various theories related to the pathogenesis of VP have been proposed, but these theories have not been critically examined and remain hypothetical. In this article, we review the possible role of endplate degeneration in the pathogenesis of VP, and discuss several pathways possibly linked to them. Due to the endplate calcification and activated cytokines, the transport pathway of the nutrition for the intervertebral disc was blocked, resulting in the metabolic unbalance and decrease of the synthesis of matrix structural proteins. It could promote the matrix decomposition, causing the decrease of the quantity of matrix and the changes of stress distribution in intervertebral disc. As a result, the structure of intervertebral discs became increasingly unstable. While compression happened, the intravertebral cleft could occur and be gradually filled with gas, which may cause low back pain and aggravate the intervertebral discs degeneration. As outlined above, we hypothesize that endplate degeneration might be the origination of the vacuum phenomenon.

Have Recent Vertebroplasty Trials Changed the Indications for Vertebroplasty?

Two different investigators in the New England Journal of Medicine recently published two randomized controlled trials (RCTs) regarding the efficacy of vertebroplasty for painful osteoporotic vertebral compression fractures. In their results, both investigators concluded that there was no significant difference in pain relief between the vertebroplasty group and control group 1 month after treatment. The trials described a different patient cohort from the one we treat with vertebroplasty. Both enrolled patients had back pain for <or=12 months. This duration of pain was far too long for a vertebroplasty trial, resulting in parallel trials of vertebroplasty on healed fractures. Where a study is needed, it should be comprised of patients with acute osteoporotic compression fractures, particularly those who are hospitalized or bedridden because of the pain of such fractures. Magnetic resonance imaging was not systematically performed before vertebroplasty, and inpatients were excluded. Inpatients with acute fracture pain are the group most likely to respond well to vertebroplasty. Enrolment was a problem in both trials. Randomization in both RCTs took >4 years for completion. We advise that vertebroplasty be offered to patients with recent fractures <8 weeks old who have uncontrolled pain as well as patients progressing to osteonecrosis and the intravertebral vacuum phenomenon (Kummels disease). The availability of recent MRI scanning is also critical to proper patient selection.

Imaging and pathologic study of intravertebral vacuum phenomenon in vertebral compression fracture

Objective To investigate the features of intravertebral vacuum phenomenon (IVP)in vertebral compression fractures (VCFs). Methods Two hundred and nine patients with VCFs underwent percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). The biopsies and the images of X-ray, CT, MRI of VCFs were obtained. The consistency between IVP and osteonecrosis on histology and the positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and Youden index of IVP for diagnosing local osteonecrosis in VCFs were analyzed. Fisher exact probability test was used to analyze the coherence between IVP and osteonecrosis. Results Histological examination revealed 146(69.9%) osteoporoses, 10 (4.8%) osteonecroses with osteoporoses, 53 (25.4%) neoplasms. Prior to surgery,10 cases of IVP were found. Plain radiograph showed horizontally oriented lucent cleft in the vertebral body;CT further confirmed the location of gas;T_1-weighted MR image appeared hypointensity,while the signal intensity of T_2-weighted MR image differed, depending on the duration of recumbency. Nine of 10 patients with IVP showed osteonecrosis on histology, while 9 of 10 patients with osteonecrosis contained IVP. The association of osteonecrosis on histology and the IVP was statistically significant(P <0.01). The PPV, NPV, sensitivity, specificity, and Youden index for diagnosing local osteonecrosis was 90% (9/10), 99.5% (198/199), 90.0% (9/10), 99.5% (198/199), and 0.9, respectively. Conclusion The IVP is stongly suggestive of local osteonecrosis in vertebral compression fracture. Key words: Spinal fracture; Fracture, compression; Osteonecrosis; Diagnostic imaging; Pathology

Analysis of Results Using Percutaneous Vertebroplasty for the Treatment of Avascular Necrosis of the Vertebral Body

Avascular necrosis (AVN) of the vertebral body is known as a relatively uncommon phenomenon in a vertebral compression fracture (VCF). The outstanding radiologic findings of AVN are intravertebral vacuum phenomenon with or without fluid collection. Several reports revealed that PVP or balloon kyphoplasty might be the effective treatment modalities for AVN. We also experienced excellent results when using PVP for the treatment of AVN of the vertebral body, and intend to describe the treatment's efficacy in this report. Thirty-two patients diagnosed with AVN of the vertebral body were treated with PVP. We measured the pre- and post-operative anterior body height and kyphotic angulation. The visual analogue scale (VAS) was used to determine the relief of back pain. The anterior body height (pre-operative : 1.49 cm, post-operative : 2.22 cm) and kyphotic angulation (pre-operative : 14.47 degrees, post-operative : 6.57 degrees) were significantly restored (p<0.001). VAS was improved from 8.9 to 3.7. Pseudoarthrosis was corrected in all cases, which was confirmed by dynamic radiographs. Fluid collection was found in sixteen cases and was aspirated with serous nature. No organism and tumor cell were noted. PVP proved to be an effective procedure for the treatment of AVN of the vertebral body, which corrected dynamic instability and significantly restored the anterior body height and kyphotic angulation.

The intravertebral vacuum phenomenon

Vertebral vacuum sign is an uncommon finding, which can easily mimic the air within the disc and can be overlooked. We present a case of intravertebral vacuum phenomenon with exquisite multidetector computed tomography and magnetic resonance imaging findings.

Osteoporotic Vertebral Fractures and Collapse With Intravertebral Vacuum Sign (K&amp;uuml;mmel&amp;#146;s Disease)

The intravertebral vacuum phenomenon was first described by Kümmel and is also known as delayed vertebral collapse or vertebral pseudarthrosis. Clinically, it occurs in approximately 10% of vertebral osteoporotic fractures, mainly in the thoracolumbar zone, is accentuated on extension views and associated with benign fractures. Most patients are neurologically intact, and continued pain is a common symptom that responds well to stabilization. Various theories exist in the literature about the pathogenesis; data support a combination of ischemia and psuedarthrosis. The ultimate treatment plan must be individualized and involve decompression of neurologic elements--when present--and sufficient stabilization, which varies according to surgeon preference and the patient's combordities.

Vertebral Osteonecrosis and Percutaneous Vertebroplasty

Vertebral osteonecrosis is characterized by the presence of the intravertebral vacuum phenomenon. It is a relatively uncommon disease and although it may be caused by different pathologies, the most frequent cause is posttraumatic. The explanation for the presence of intravertebral gas is not known completely. We present the case of a 74-year-old patient who after suffering a vertebral traumatism, to complain of intense vertebral pain. A simple radiological study, CT scan, and magnetic resonance confirmed the presence of intravertebral vacuum phenomenon. We studied this radiological sign and then commented on its evolution after percutaneous vertebroplasty.

Benign nontraumatic osteolytic vertebral collapse simulating malignancy

This study described the imaging features of a distinctive pattern of biopsy-proven benign non-traumatic vertebral collapse (VC) that can mimic malignancy. Among 240 patients referred with painful VC over a 10-year period, we retrospectively selected 15 cases of benign VC which simulated malignancy, due to cortical bone destruction on radiographs. The diagnosis of benign origin was documented by percutaneous biopsy and 12-months of follow-up. Radiographs, CT and MR images of the spine were reviewed. Findings suggestive of malignancy included destruction involving the anterolateral cortex, posterior cortex and pedicles of the vertebral body (46%,15% and 15% respectively) at CT, epidural soft-tissue masses on CT (23%) and MR images (21%), and diffuse low signal-intensity (SI) of the vertebral body (50%) and pedicles (79%) on T1-weighted images. Features suggestive of a benign origin included an intravertebral vacuum phenomenon on radiographs and CT (13%), fracture lines within the vertebral body (92%) or pedicles (62%) at CT and presence an intravertebral area of high SI on T2-weighted images (93%). Benign non-traumatic osteolytic VC can simulate malignancy on radiographs. The features, above mentioned on CT and MR suggestive of a benign VC, are useful in interpreting biopsy results of such lesions and avoiding unnecessary repeat biopsy.

The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study

This study investigated the prevalence of the intravertebral vacuum phenomenon (IVP) and osteonecroses in vertebral compression fractures (VCFs). We therefore performed an histological analysis of biopsies obtained from VCFs prior to balloon kyphoplasty. Computed tomography (CT) scans were reviewed regarding the presence of an IVP (i.e. cleft sign, Kümmell disease). We reviewed the data of 266 consecutive patients treated by balloon kyphoplasty in 501 procedures from 2002 to 2004. From 180 patients (68%) we obtained adequate bone tissue for histological evaluation. Biopsy specimens were analysed regarding the presence of osteoporosis, infection, malignancy and osteonecrosis. CT scans of all 180 patients were reviewed for presence of an IVP. Histological examination revealed 135 (75%) osteoporoses, 20 (11%) neoplasms, 12 (7%) trauma cases and 13 (7%) osteonecroses. An IVP was present in 12 (7%) patients. There was a significant association of osteonecrosis and IVP (P < 0.0001). Eleven of 12 patients with a vacuum phenomenon showed an osteonecrosis on histology, whereas 11 of 13 patients with osteonecrosis showed an IVP on CT. The IVP is a specific sign of osteonecrosis in vertebral compression fractures (sensitivity 85%, specificity 99%, positive predictive value 91%). Our findings strongly support the thesis that an IVP indicates local bone ischemia associated with a non-healing vertebral collapse and pseudarthrosis.

Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of intravertebral instability.

The objectives of this study were to: 1) describe the incidence and clinical features of intravertebral vacuum phenomenon (IVVP) in a relatively large number of cases; 2) quantitatively evaluate intravertebral instability and determine the factors affecting instability; and 3) evaluate the efficacy of percutaneous vertebroplasty in the treatment of this phenomenon. A retrospective review was conducted of the records of 67 patients with IVVP among 652 consecutive cases of osteoporotic compression fracture. Comparisons between the IVVP group and a control group, a stable group, and an unstable group were conducted. Percutaneous vertebroplasty was performed in all patients. There were 67 patients (10.3%) in whom there were 70 vacuum phenomena of the intravertebral space. Intravertebral vacuum phenomena occurred predominantly in the thoracolumbar junction (81%) and in patients with a longer duration of symptoms (10.6 +/- 9.8 months) compared with the control group. Of 59 vertebrae for which flexion-extension radiographs were available, 26 vertebrae were categorized as stable and 33 as unstable. Twenty-one vertebrae (64%) had undergone compression fracture in the unstable group compared with nine (35%) compression fractures in the stable group. There were 28 (85%) fractures of the wedged vertebrae in the unstable group compared with 16 (61%) fractures in wedged vertebrae in the stable group. Percutaneous vertebroplasty was performed with successful clinical outcome. Intravertebral vacuum phenomenon is more common than has been previously appreciated. The results of this study indicate that biomechanics, not ischemic or avascular theory, may play an important role in pathogenesis of this phenomenon. Percutaneous vertebroplasty was found to be a minimally invasive and effective procedure for the treatment of IVVP.

Efficacy of Percutaneous Vertebroplasty in the Treatment of Intravertebral Pseudarthrosis Associated With Noninfected Avascular Necrosis of the Vertebral Body

A retrospective clinical study on the effect of percutaneous vertebroplasty (PVP) in the treatment of intravertebral pseudarthrosis caused by avascular necrosis of a vertebral body. To evaluate the efficacy of PVP in the treatment of spinal instability associated with avascular necrosis. Two radiologic features of avascular necrosis of a vertebral body are intravertebral vacuum phenomenon and fluid collection, combined with a collapsed vertebra. These can sometimes result in dynamic instability due to intravertebral pseudarthrosis. A treatment for this instability, associated with avascular necrosis, has not been established. Sixteen patients with instability, associated with avascular necrosis of a vertebral body, were treated by PVP. The indicators of the condition included spinal instability associated with avascular necrosis, which was diagnosed by a vacuum phenomenon or by fluid collection in the vertebral body as found from imaging studies. The instability of the vertebral body was confirmed from the dynamic lateral view in both flexion and extension. The anterior body height and kyphotic angle changes between pre- and post-treatment were measured on a lateral radiograph. Plain radiography was used during the follow-up period (8-14 months; mean, 11 months) to assess the vertebral column stability. The pain level of each patient was assessed, both before and after the procedure, using a visual analog scale (VAS), ranging from 0 to 10. Marked or complete pain relief was achieved in eight (50%) patients, and moderate pain relief in six (38%), with the immediate postoperative average pain score reduced from 9.0 to 4.3. The mean corrected angle and vertebral height between pre- and post-treatment were 8.5 degrees and 7.0 mm (P =0.001), respectively. There was no significant change in the kyphotic angle of the treated level during the follow-up period (P =0.711). Percutaneous vertebroplasty is a reasonable procedure for the treatment of spinal instability associated with avascular necrosis, but not that caused by an infection. PVP was found to be a minimally invasive and effective procedure that provides pain relief and stabilization of spinal instability associated with noninfected avascular necrosis of the vertebral body.

Intravertebral Vacuum Phenomenon that Developed During Transpedicular Biopsy

Intravertebral Vacuum Phenomenon that Developed During Transpedicular Biopsy

Delayed posttraumatic vertebral collapse with intravertebral vacuum cleft

Objective: To discuss the case of a 79-year-old man who had a delayed posttraumatic vertebral collapse and an intravertebral vacuum cleft. The patient had been on long-term corticosteroid therapy. A discussion of Kummell's diseaseand the controversy surrounding the etiology of the condition is also presented. Clinical Features: Six weeks before coming to the clinic, the patient remembered twisting, hearing a pop, and having severe low back pain. Two weeks after the incident, while hospitalized for bacterial cellulitis, he underwent lumbar spine radiography. The radiographs showed degenerative changes and remote (healed) compression fractures but did not demonstrate any deformity of L2. Four weeks later, he sought care for persistent low back pain. Radiographs revealed marked compression of the L2 vertebral body with an intravertebral vacuum phenomenon. Intervention and Outcome: The patient was referred to his geriatrician for evaluation as a candidate for vertebroplasty or other stabilization procedures. He required a moderately high dose (60 mg) of prednisone daily to combat the symptoms of myasthenia gravis; therefore, the prognosis appears unfavorable for this patient. Conclusion: Clinical research is needed to determine the definitive etiology and pathophysiology of Kummell's disease. This case demonstrates that the intravertebral vacuum is a dynamic entity, subject to changes in size and shape. Previous case reports have suggested that Kummell's disease only presents as a linear, horizontal cleft. This disease needs further investigation to determine the true correlation between radiographic signs and the underlying pathophysiology. (J Manipulative Physiol Ther 2002;25:270-275)

Kummell's Disease Managed by Percutaneous Vertebroplasty

Study Design : Prospective study about fourteen consecutive patients with Kummell’s disease who were treated by percutaneous vertebroplasty with bone cement. Objectives : To evaluate the results of percutaneous vertebroplasty using bone cement in the treatment of Kummell’s disease. Summary of Literature Review : Kummell’s disease is a rarely reported, poorly documented, and poorly understood phenomenon. It is associated with intravertebral vacuum phenomenon and clinically manifested by painful kyphosis. The treatment of the disease had been conservative or surgical reconstruction, but both conservative and operative treatment were not satisfactory in some patients. Materials and Methods : A review was conducted of 14 patients with 18 vertebrae treated with percutaneous vertebroplasty from June 1999 to May 2000. They had posttraumatic vertebral collapse or Kummell’s disease and had failed medical therapy. Immediate and long-term pain response and complications of percutaneous vertebroplasty with bone cement were evaluated. R e s u l t s : All patients reported complete relief of pain within the first 24 hours. Ten(71.5%) were evaluated as excellent; three(21.4%), good; one(7.1%), fair until 3 months postoperatively. Eight(57.2%) were evaluated as excellent; four(28.6%), good; fair(7.1%), one; poor(7.1%), one at final follow-up. Five(35.7%) patients had cement extrusion into the disc, paravertebral vessels and epidural space without significant systemic symptoms. C o n c l u s i o n : For patients with posttraumatic vertebral collapse or Kummell’s disease, percutaneous vertebroplasty technique using bone cement would be a minimally invasive treatment option to achieve immediate relief of pain and stabilization without significant side effects.

Intravertebral vacuum phenomenon following fractures: CT study on frequency and etiology.

The purpose of this work was to determine the frequency and etiology of the intravertebral vacuum phenomenon (IVP). CT examinations of 96 vertebral fractures were evaluated for IVP. Bone mineral density (BMD) was determined in nonfractured vertebrae. For calibration purposes, densities of a standard phantom measured in 30 patients who underwent quantitative CT examinations in the same time period were used and precision was calculated. Eleven of 96 fractures (11.5%) showed IVP. IVP was present in 4 of 20 fractures at T12 (20%), in 4 of 23 at L1 (17.4%), and 1 IVP was found at L2-4 each. Mean +/- SD age of patients with IVP was 68.3 +/- 10.5 years and without 47.8 +/- 19.4 years (p < 0.001). Mean +/- SD density of nonaffected vertebra was 45.9 +/- 17.0 mg of hydroxyapatite/ml for patients with IVP and 139.5 +/- 62.6 mg/ml for those without IVP (p < 0.0005). An average precision of 1.2% was calculated for the density measurements over the investigated time. Following vertebral fractures, IVP on CT scans is more common than presumed and increases with age. There exists a significant inverse correlation between the BMD and the frequency of IVP.

The linear intravertebral vacuum: a sign of benign vertebral collapse.

We describe 11 patients with radiographically visible linear intravertebral vacuums to increase awareness of this benign finding that is diagnostic of ischemic necrosis of the vertebral body (Kümmell's disease). We retrospectively reviewed the radiologic and clinical histories of 11 patients seen at our institution between 1991 and 1997 in whom the linear intravertebral vacuum phenomenon had been diagnosed. Imaging included plain radiographs in all patients, CT scans in three, bone scintigrams in three, and MR images in three. Twelve linear intravertebral vacuums associated with vertebral compression deformities were visible in 11 patients from T8 to L2, four at T12, and four at L1. Of the 12 linear intravertebral vacuums, seven (58%) were seen by the initial interpreting radiologist. The mean age of these patients was 76.6 years. The female:male ratio was 10:1. During the period of analysis, two patients were known to have malignancy, one with metastasis to the spine but not to the affected vertebral body. One patient, who underwent equivocal MR imaging for malignancy, later underwent bone biopsy, which showed no neoplasm within the collapsed vertebra. Of the remaining nine patients, one was undergoing chronic corticosteroid therapy and another had a history of radiation therapy to the spine. Seven of the 11 patients had histories of falling, prompting radiographs of the spine. All 11 patients were radiographically osteopenic. Ultimately, none of the patients had clinical evidence of neoplasm or infection involving the affected vertebral body. Recognition of the near-certain benign significance of a linear intravertebral gas collection revealed by radiography may prevent unnecessary imaging or biopsy in a patient with a suggestive vertebral compression deformity.

The Intravertebral Vacuum Phenomenon ("Vertebral Osteonecrosis")

Retrospective cohort. To compare the prevalence of the association between contiguous intervertebral disc and vertebral collapses with or without an intravertebral vacuum phenomenon. The mechanism of occasional gas accumulation within some vertebral collapses is poorly known. The current hypothesis is that this phenomenon is indicative of bone ischemia. In fact, avascular necrosis as the main pathologic event remains speculative, and should not explain per se the presence of gas within a vertebral body. Comparison of the prevalence of intervertebral disc vacuum phenomenon adjacent to the affected vertebral body in 23 cases of intravertebral vacuum phenomenon in 19 patients (intravertebral vacuum phenomenon group) and in 708 osteoporotic collapses without intravertebral vacuum phenomenon in 199 patients (control group). There were no differences in sex and age between the two groups, and all the patients in the intravertebral vacuum phenomenon group had signs of underlying osteoporosis. A vacuum phenomenon in at least one intervertebral disc adjacent to the collapses on radiographs, conventional tomography, computed tomography, or magnetic resonance imaging was found in 19 cases (83%) in the intravertebral vacuum phenomenon group, compared with 13% in the control group (P < 0.0001). Considering plain radiographs only, this association was found in 50% of the intravertebral vacuum phenomenon group and in 9.7% of the control group (P < 0.0001). The intervertebral and intravertebral gaseous collections were connected through a fractured endplate in six cases. The high prevalence of the association of contiguous intervertebral and intravertebral vacuum phenomenon could have implications in the pathogenesis of the intravertebral vacuum phenomenon. We hypothesize that the intravertebral vacuum phenomenon could simply be the result of migration of an intradiscal-gaseous collection through the fractured endplate of some osteoporotic collapses.