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

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Abstract

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, wheras 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.

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Authors and Affiliations

  1. Department of Radiology, University of Cologne, Kerpener Strasse 62, 50937, Köln, Germany

    Martin Libicher

  2. Department of Trauma Surgery, University of Heidelberg, Heidelberg, Germany

    Andreas Appelt, Martin Baier, Peter-Jürgen Meeder & Katharina DaFonseca

  3. Department of Pathology, University of Heidelberg, Heidelberg, Germany

    Irina Berger

  4. Department of Internal Medicine, Division of Osteology, University of Heidelberg, Heidelberg, Germany

    Ingo Grafe & Christian Kasperk

  5. Department of Radiology, University of Heidelberg, Heidelberg, Germany

    Gerd Nöldge

Authors
  1. Martin Libicher
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  2. Andreas Appelt
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  3. Irina Berger
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  4. Martin Baier
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  5. Peter-Jürgen Meeder
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  6. Ingo Grafe
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  7. Katharina DaFonseca
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  8. Gerd Nöldge
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  9. Christian Kasperk
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Corresponding author

Correspondence to Martin Libicher.

Additional information

This paper is dedicated to Professor G.W. Kauffmann, Heidelberg, Germany

M. Libicher and A. Appelt contributed equally to this work

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Libicher, M., Appelt, A., Berger, I. et al. The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study. Eur Radiol 17, 2248–2252 (2007). https://doi.org/10.1007/s00330-007-0684-0

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  • DOI: https://doi.org/10.1007/s00330-007-0684-0

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