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Pseudoarthrosis of vertebral fracture: radiographic and characteristic clinical features and natural history

Journal of Orthopaedic Science

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We examined mobility based on radiographic appearance, clinical appearance, and the natural course of osteoporotic vertebral pseudoarthrosis (VPA) in a prospective study in 34 consecutive cases of VPA in 27 patients with osteoporosis.


Conventional lateral, lateral flexion, and extension stress radiography (XP) and supine cross-table lateral XP were performed. Anterior vertebral body height and vertebral kyphotic angle were measured to assess vertebral mobility. If vertebral cleft or vertebral instability, which means a difference in vertebral body height between conventional and supine cross-table lateral XP, was present, VPA was diagnosed. Back pain was classified into five grades.


The average anterior vertebral height was 9.9 ± 5.6 mm on conventional lateral XP; it increased to 11.4 ± 6.5 mm on extension stress XP (not significant) and 18.3 ± 5.7 mm on cross-table lateral XP (significant). The verte-bral kyphotic angle was 24.1° ± 9.7° on conventional lateral XP; it decreased to 21.6° ± 9.8° on extension stress XP (not significant) and 11.8° ± 8.5° on cross-table lateral XP (significant). Intravertebral clefts were detected by conventional lateral XP, extension stress XP, and supine cross-table XP in 3 of 34 (8.8%), 7 of 21 (33.3%), and 28 of 34 (82.4%) vertebral compression fractures (VCFs), respectively. Surgical treatment was performed in seven patients (two because of severe pain and five because of neurological deficits) and in one patient who died. Except in these eight patients, back pain decreased by at least one grade with time in 18 of 19 patients (95%) in whom the clinical course was analyzed. Radiographic follow-up using supine cross-table XP was performed in 15 of 19 patients. Although 11 of these 15 patients (73%) showed vertebral instability on supine cross-table lateral XP, 10 of 11 patients (91%) did not complain of intolerable back pain during daily activity at the final follow-up.


VPA is often detected on supine cross-table lateral XP but not usually on extension stress XP. Despite the presence of vertebral instability, many patients did not complain of intolerable back pain during their daily activity. Surgical treatment to alleviate back pain should be performed for painful VPA after conservative treatment for about 4 months.

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  1. BE Maldague HM Noel JJ Malghem (1978) ArticleTitleThe intravertebral vacuum cleft: a sign of ischemic vertebral collapse Radiology 129 23–9 Occurrence Handle1:STN:280:DyaE1M%2FhtlWmug%3D%3D Occurrence Handle693884

    CAS  PubMed  Google Scholar 

  2. AC Brower EF Downey SuffixJr (1981) ArticleTitleKümmell disease: report of a case with serial radiographs Radiology 141 363–4 Occurrence Handle1:STN:280:DyaL38%2FjvVGlsA%3D%3D Occurrence Handle7291557

    CAS  PubMed  Google Scholar 

  3. LH Chou RQ Knight (1997) ArticleTitleIdiopathic avascular necrosis of a vertebral body: case report and literature review Spine 22 1928–32 10.1097/00007632-199708150-00024 Occurrence Handle10.1097/00007632-199708150-00024 Occurrence Handle1:STN:280:DyaK2svisF2rsA%3D%3D Occurrence Handle9280031

    Article  CAS  PubMed  Google Scholar 

  4. DJ Theodorou (2001) ArticleTitleThe intravertebral vacuum cleft sign Radiology 221 787–8 Occurrence Handle10.1148/radiol.2213991129 Occurrence Handle1:STN:280:DC%2BD3MnntlyjtA%3D%3D Occurrence Handle11719679

    Article  CAS  PubMed  Google Scholar 

  5. W Kumpan E Salomonowitz G Seidl GR Wittich (1986) ArticleTitleThe intravertebral vacuum phenomenon Skeletal Radiol 15 444–7 Occurrence Handle10.1007/BF00355102 Occurrence Handle1:STN:280:DyaL2s%2FhvV2mug%3D%3D Occurrence Handle3764471

    Article  CAS  PubMed  Google Scholar 

  6. K Kaneda S Asano T Hashimoto S Satoh M Fujiya (1992) ArticleTitleThe treatment of osteoporotic posttraumatic vertebral collapse using the Kaneda device and bioactive ceramic vertebral prosthesis Spine 17 S295–303 Occurrence Handle10.1097/00007632-199208001-00015 Occurrence Handle1:STN:280:DyaK38zpslWgtA%3D%3D Occurrence Handle1523516

    Article  CAS  PubMed  Google Scholar 

  7. K Hasegawa T Homma S Uchiyama H Takahashi (1998) ArticleTitleVertebral pseudarthrosis in the osteoporotic spine Spine 23 2201–6 Occurrence Handle10.1097/00007632-199810150-00011 Occurrence Handle1:STN:280:DyaK1M%2FhvV2ksg%3D%3D Occurrence Handle9802162

    Article  CAS  PubMed  Google Scholar 

  8. DY Kim SH Lee JS Jang SK Chung HY Lee (2004) ArticleTitleIntravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of intravertebral instability J Neurosurg Spine 100 24–31 Occurrence Handle10.3171/spi.2004.100.1.0024

    Article  Google Scholar 

  9. H Baba Y Maezawa K Kamitani N Furusawa S Imura K Tomita (1995) ArticleTitleOsteoporotic vertebral collapse with late neurological complications Paraplegia 33 281–9 Occurrence Handle1:STN:280:DyaK2MzlslSrtg%3D%3D Occurrence Handle7630656

    CAS  PubMed  Google Scholar 

  10. Y Ito Y Hasegawa K Toda S Nakahara (2002) ArticleTitlePathogenesis and diagnosis of delayed vertebral collapse resulting from osteoporotic spinal fracture Spine J 2 101–6 10.1016/S1529-9430(01)00165-6 Occurrence Handle10.1016/S1529-9430(01)00165-6 Occurrence Handle14588268

    Article  PubMed  Google Scholar 

  11. J Mochida E Toh M Chiba K Nishimura (2001) ArticleTitleTreatment of osteoporotic late collapse of a vertebral body of thoracic and lumbar spine J Spinal Disord 14 393–8 Occurrence Handle10.1097/00002517-200110000-00004 Occurrence Handle1:STN:280:DC%2BD3MrjvFSqsw%3D%3D Occurrence Handle11586138

    Article  CAS  PubMed  Google Scholar 

  12. F Denis GW Armstrong K Searls L Matta (1984) ArticleTitleAcute thoracolumbar burst fractures in the absence of neurologic decifit: a comparison between operative and nonoperative treatment Clin Orthop 189 142–9 Occurrence Handle6478691

    PubMed  Google Scholar 

  13. RL Pentecost RA Murray HH Brindley (1964) ArticleTitleFatigue, insufficiency, and pathologic fractures JAMA 187 1001–4 Occurrence Handle1:STN:280:DyaF2c%2FmtVKitQ%3D%3D Occurrence Handle14102934

    CAS  PubMed  Google Scholar 

  14. K Takahara M Kamimura H Nakagawa S Uchiyama (2004) ArticleTitleChanges in biochemical markers of bone in patients with insufficiency fractures J Bone Miner Metab 22 618–25 10.1007/s00774-004-0532-0 Occurrence Handle10.1007/s00774-004-0532-0 Occurrence Handle15490274

    Article  PubMed  Google Scholar 

  15. SL Silverman ME Minshall W Shen KD Harper S Xie (2001) ArticleTitleHealth-related Quality of Life Subgroup of the Multiple Outcomes of Raloxifene Evaluation Study: the relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis: results from the Multiple Outcomes of Raloxifene Evaluation Study Arthritis Rheum 44 2611–9 10.1002/1529-0131(200111)44:11<2611::AID-ART441>3.0.CO;2-N Occurrence Handle10.1002/1529-0131(200111)44:11<2611::AID-ART441>3.0.CO;2-N Occurrence Handle1:STN:280:DC%2BD3MnmsFeqsg%3D%3D Occurrence Handle11710717

    Article  CAS  PubMed  Google Scholar 

  16. KE Ensrud DE Thompson JA Cauley MC Nevitt DM Kado MC Hochberg et al. (2000) ArticleTitlePrevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass; Fracture Intervention Trial Research Group J Am Geriatr Soc 48 241–9 Occurrence Handle1:STN:280:DC%2BD3c7psFWrtA%3D%3D Occurrence Handle10733048

    CAS  PubMed  Google Scholar 

  17. TM Vogt PD Ross L Palermo T Musliner HK Genant D Black et al. (2000) ArticleTitleVertebral fracture prevalence among women screened for the fracture intervention trial and a simple clinical tool to screen for undiagnosed vertebral fractures Mayo Clin Proc 75 888–96 Occurrence Handle10.4065/75.9.888 Occurrence Handle1:STN:280:DC%2BD3cvksVCnuw%3D%3D Occurrence Handle10994823

    Article  CAS  PubMed  Google Scholar 

  18. GJR Cook E Hannaford M See SEM Clarke I Fogelman (2002) ArticleTitleThe value of bone scintigraphy in the evaluation of osteoporotic patients with back pain Scand J Rheumatol 31 245–8 10.1080/030097402320318459 Occurrence Handle10.1080/030097402320318459 Occurrence Handle1:STN:280:DC%2BD38nht1Cmsg%3D%3D Occurrence Handle12369658

    Article  CAS  PubMed  Google Scholar 

  19. PD Ross (1997) ArticleTitleClinical consequences of vertebral fractures Am J Med 103 30S–42S 10.1016/S0002-9343(97)90025-5 Occurrence Handle10.1016/S0002-9343(97)90025-5 Occurrence Handle1:STN:280:DyaK2svkvVGluw%3D%3D Occurrence Handle9302895

    Article  CAS  PubMed  Google Scholar 

  20. K Takahara M Kamimura H Nakagawa T Itsubo S Uchiyama T Miyasaka (2003) ArticleTitleDiagnosis of vertebral compression fracture using magnetic resonance imaging Nihon Sekituisekizuibyougakkai Zasshi (Journal of the Japanese Spine Research Society) 14 393

    Google Scholar 

  21. F McKiernan T Faciszewski (2003) ArticleTitleIntravertebral clefts in osteoporotic vertebral compression fractures Arthritis Rheumatol 5 1414–9 Occurrence Handle10.1002/art.10984

    Article  Google Scholar 

  22. NB Watts ST Harris HK Genant (2001) ArticleTitleTreatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty Osteoporos Int 12 429–37 Occurrence Handle10.1007/s001980170086 Occurrence Handle1:STN:280:DC%2BD3Mzpt1eguw%3D%3D Occurrence Handle11446557

    Article  CAS  PubMed  Google Scholar 

  23. JK McGraw JA Lippert KD Minkus PM Rami TM Davis RF Budzik (2002) ArticleTitleProspective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up J Vasc Interv Radiol 13 883–6 Occurrence Handle10.1016/S1051-0443(07)61770-9 Occurrence Handle12354821

    Article  PubMed  Google Scholar 

  24. TH Diamond B Champion WA Clark (2003) ArticleTitleManagement of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy Am J Med 114 257–65 10.1016/S0002-9343(02)01524-3 Occurrence Handle10.1016/S0002-9343(02)01524-3 Occurrence Handle12681451

    Article  PubMed  Google Scholar 

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Hashidate, H., Kamimura, M., Nakagawa, H. et al. Pseudoarthrosis of vertebral fracture: radiographic and characteristic clinical features and natural history. J Orthop Sci 11, 28–33 (2006).

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