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Injury to the vertebral endplate-disc complex associated with osteoporotic vertebral compression fractures 2009

Interventional Spine

Ritu Bordia, MBBS, MPH,
Orlando A Ortiz, MD, MBA, ASSR Member

Scientific Paper

Mentor Award: Yes

Institution where work was conducted

Winthrop-University Hospital

Affiliation and Department

WUH / Internal Medicine

Address

260 First St
Apt B7
Mineola, New York
11501
Phone: 516-313-4921
Email: ritu.bordia@gmail.com

Purpose

To assess the incidence of vertebral endplate and/or intervertebral disc injury in patients experiencing painful osteoporotic vertebral injury.

Methods & Materials

The magnetic resonance imaging (MRI) examinations of the thoraco-lumbar spine were reviewed by an experienced neuroradiologist in 84 patients who were evaluated for severe back pain and who subsequently were found to have one or more osteoporotic vertebral compression fractures (oVCF’s). The patients ranged in age from 40 to 93 years-old with a mean age of 79.8 years. 70 patients were female and 14 patients were male. A total of 170 acute or subacute vertebral compression fractures, as determined by the presence of marrow edema on T2 weighted and/or inversion recovery sequences were identified in this patient sample. Endplate injury was determined by the presence of endplate edema or fluid collection, or cortical discontinuity or angulation, or intrusion of disc material into the endplate. Disc injury was identified by the presence of disc edema or morphologic alteration (when compared to adjacent levels). These findings were recorded for each fracture level and the adjacent intervertebral disc. They were also subsequently compared to the written Radiology reports of this patient group. Institutional IRB approval was obtained prior to conducting this study.

Results

74 oVCF’s were located in the thoracic spine and 96 oVCF’s were located in the lumbar spine. Endplate injury, as evidenced by the presence of endplate edema or fluid collection, or cortical discontinuity or angulation, or intrusion of disc material into the endplate, was observed in 130 of the 170 levels studied (76%). Superior endplate injury was more common as either an isolated event in 58 levels (34%) or in combination with inferior endplate injury in another 58 levels (total superior endplate injury = 68%). Inferior endplate injury was observed in 14 levels as an isolated event or in combination with superior endplate injury in 58 levels (total inferior endplate injury = 42%). Disc injury, as evidenced by the presence of disc edema or morphologic alteration (when compared to adjacent levels), was observed in 144 of the 170 levels (79%) that were studied. The disc above the oVCF was injured in 110 of the 170 levels (65%) and the disc below the oVCF was injured in 71 of the 170 levels (42%). The combination of disc and endplate injury was observed in 109 out of the 170 levels (64%). Disc injury was not mentioned in any of the official Radiology reports in these 84 MRI studies, whereas endplate injury was either indirectly or directly referred to in 30 of the MRI studies (35%).

Conclusion

Vertebral endplate injury is commonly seen in osteoporotic vertebral compression fractures. Furthermore, this is frequently associated with injury to the adjacent intervertebral disc. These findings are often underreported, but should be described as they may have important implications for symptomatic presentation, patient management, and patient outcomes.

References

1. Lin EP et al. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body.AJNR Am J Neuroradiol. 2004 Feb;25(2):175-80.

2. Boger A, et al. Adjacent vertebral failure after vertebroplasty: a biomechanical study of low-modulus PMMA cement.Eur Spine J. 2007 Dec;16(12):2118-25.

3. Baroud G, et al. Load shift of the intervertebral disc after a vertebroplasty: a finite-element study.Eur Spine J. 2003 Aug;12(4):421-6.

Financial Disclosures:
AO Ortiz
SpineWave Corp (Shelton, CT)- Consultant
Medtronic Spine (Memphis, TN)- Speakers bureau