Neuroradiology

, Volume 54, Issue 10, pp 1137–1143

Osteoporotic vertebral fractures without compression: key factors of diagnosis and initial outcome of treatment with cement augmentation

  • Haiqing Mao
  • Jun Zou
  • Dechun Geng
  • Xuesong Zhu
  • Mo Zhu
  • Weimin Jiang
  • Huilin Yang
Interventional Neuroradiology

Abstract

Introduction

Because of the nonspecific symptoms and unapparent radiographic findings, occult osteoporotic vertebral fractures (VFs) have a high rate of missed diagnosis, and the treatment of these fractures has rarely been discussed in the literature. We investigated diagnostic key factors of such occult VFs and evaluated the effects of cement augmentation in these patients.

Methods

A total of 225 patients with VFs treated with vertebroplasty (VP) or kyphoplasty (KP) were retrospectively analyzed. All patients have taken preoperatively magnetic resonance imaging (MRI) including T1/T2-weighted images and short tau inversion recovery (STIR) sequences, and 45 patients met the inclusion criteria. Clinical outcomes were evaluated by comparing visual analog scale (VAS) and Oswestry disability index (ODI) values preoperatively, postoperatively, and at the final follow-up.

Results

MRI (T1 and STIR sequences) showed bone marrow edema in all fresh fractures including occult VFs and concomitant VFs; five patients showed no abnormality signal in their T2-weighted sequences of occult VFs. While 40 patients underwent KP, and five patients underwent VP. We did not find delayed collapsed fractures in the augmented occult VFs in both groups after operation. Both groups had significant improvement in pain and functional activity after the intervention (p<0.01).

Conclusion

The presence of previous or concomitant VFs leads to further imaging examination, which helps identify the occult VFs. Preoperative MRI examination especially T1 and STIR sequences plays a vital role in the early diagnosis of occult VFs. Except for significant pain relief and functional improvement, VP and KP can effectively prevent delayed vertebral collapse of occult VFs comparing to previous reported data.

Keywords

Insufficiency fractures Osteoporosis Vertebroplasty Kyphoplasty Magnetic resonance imaging 

References

  1. 1.
    Center JR, Nguyen TV, Schneider D et al (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882PubMedCrossRefGoogle Scholar
  2. 2.
    Bliuc D, Nguyen ND, Milch VE et al (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521PubMedCrossRefGoogle Scholar
  3. 3.
    Buchbinder R, Osborne RH, Ebeling PR et al (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361:557–568PubMedCrossRefGoogle Scholar
  4. 4.
    Kallmes DF, Comstock BA, Heagerty PJ et al (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361:569–579PubMedCrossRefGoogle Scholar
  5. 5.
    Hulme PA, Krebs J, Ferguson SJ et al (2006) Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine 31:1983–2001PubMedCrossRefGoogle Scholar
  6. 6.
    Lee MJ, Dumonski M, Cahill P et al (2009) Percutaneous treatment of vertebral compression fractures: a meta-analysis of complications. Spine 34:1228–1232PubMedCrossRefGoogle Scholar
  7. 7.
    McKiernan FE (2009) The broadening spectrum of osteoporotic vertebral fracture. Skeletal Radiol 38:303–308PubMedCrossRefGoogle Scholar
  8. 8.
    Spiegl UJ, Beisse R, Hauck S et al (2009) Value of MRI imaging prior to a kyphoplasty for osteoporotic insufficiency fractures. Eur Spine J 18:1287–1292PubMedCrossRefGoogle Scholar
  9. 9.
    Benz BK, Gemery JM, McIntyre JJ et al (2009) Value of immediate preprocedure magnetic resonance imaging in patients scheduled to undergo vertebroplasty or kyphoplasty. Spine 34:609–612PubMedCrossRefGoogle Scholar
  10. 10.
    Pham T, Azulay-Parrado J, Champsaur P et al (2005) “Occult” osteoporotic vertebral fractures: vertebral body fractures without radiologic collapse. Spine 30:2430–2435PubMedCrossRefGoogle Scholar
  11. 11.
    Belkoff SM, Jasper LE, Stevens SS (2002) An ex vivo evaluation of an inflatable bone tamp used to reduce fractures within vertebral bodies under load. Spine 27:1640–1643PubMedCrossRefGoogle Scholar
  12. 12.
    Belkoff SM, Mathis JM, Jasper LE et al (2001) The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior. Spine 26:1537–1541PubMedCrossRefGoogle Scholar
  13. 13.
    Klazen CA, Lohle PN, de Vries J et al (2010) Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 376(9746):1085–1092PubMedCrossRefGoogle Scholar
  14. 14.
    Yang X, Mi S, Mahadevia AA et al (2008) Pain reduction in osteoporotic patients with vertebral pain without measurable compression. Neuroradiology 50:153–159PubMedCrossRefGoogle Scholar
  15. 15.
    Genant HK, Wu CY, van Kuijk C et al (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148PubMedCrossRefGoogle Scholar
  16. 16.
    Do HM (2000) Magnetic resonance imaging in the evaluation of patients for percutaneous vertebroplasty. Top Magn Reson Imaging 11:235–244PubMedCrossRefGoogle Scholar
  17. 17.
    Tanigawa N, Komemushi A, Kariya S et al (2006) Percutaneous vertebroplasty: relationship between vertebral body bone marrow edema pattern on MR images and initial clinical response. Radiology 239:195–200PubMedCrossRefGoogle Scholar
  18. 18.
    Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine 25:2940–2952PubMedCrossRefGoogle Scholar
  19. 19.
    Yang HL, Wang GL, Niu GQ et al (2008) Using MRI to determine painful vertebrae to be treated by kyphoplasty in multiple-level vertebral compression fractures: a prospective study. J Int Med Res 36:1056–1063PubMedGoogle Scholar
  20. 20.
    Zou J, Mei X, Gan M et al (2010) Is kyphoplasty reliable for osteoporotic vertebral compression fracture with vertebral wall deficiency? Injury 41:360–364PubMedCrossRefGoogle Scholar
  21. 21.
    Antonacci MD, Mody DR, Rutz K et al (2002) A histologic study of fractured human vertebral bodies. J Spinal Disord Tech 15:118–126PubMedCrossRefGoogle Scholar
  22. 22.
    Chou LH, Knight RQ (1997) Idiopathic avascular necrosis of a vertebral body. Case report and literature review. Spine 22:1928–1932PubMedCrossRefGoogle Scholar
  23. 23.
    Prakash PLV, Saralaya VV et al (2007) Vertebral body integrity: a review of various anatomical factors involved in the lumbar region. Osteoporos Int 18:891–903PubMedCrossRefGoogle Scholar
  24. 24.
    Wang G, Yang H, Chen K (2010) Osteoporotic vertebral compression fractures with an intravertebral cleft treated by percutaneous balloon kyphoplasty. J Bone Joint Surg Br 92:1553–1557PubMedCrossRefGoogle Scholar
  25. 25.
    Yu CW, Hsu CY, Shih TT et al (2007) Vertebral osteonecrosis: MR imaging findings and related changes on adjacent levels. AJNR Am J Neuroradiol 28:42–47PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Haiqing Mao
    • 1
  • Jun Zou
    • 1
  • Dechun Geng
    • 1
  • Xuesong Zhu
    • 1
  • Mo Zhu
    • 1
  • Weimin Jiang
    • 1
  • Huilin Yang
    • 1
  1. 1.Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina

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