Relationship between vertebral instability caused by intravertebral clefts and neurologic injury / 中国组织工程研究

ABSTRACT

BACKGROUND: The details of clinical symptoms of osteoporotic vertebral fracture with intravertebral clefts are poorly understood at present. OBJECTIVE: To investigate the relationship between clinical symptoms and imaging features of osteoporotic vertebral fracture with intravertebral clefts. METHODS: Clinical data of 168 patients with single-level osteoporotic vertebral fracture with intravertebral clefts were retrospectively analyzed. The clinical symptoms were evaluated by Visual Analogue Scale score and Oswestry Disability Index. The incidence of delayed neurologic deficit was recorded. X-ray was used to measure the local kyphosis angle and vertebral instability, and CT was used to diagnose the posterior wall fracture of the vertebral body. The relationship between clinical symptoms and imaging features of osteoporotic vertebral fracture with intravertebral clefts was analyzed. RESULTS AND CONCLUSION: (1) The Visual Analogue Scale score and Oswestry Disability Index were 7.7±1.6 and (62.9±19.2)%, respectively. Delayed neurologic deficit occurred in 37 patients (22.0%). Local kyphosis angle and vertebral instability was (16.8±7.7)° and (7.9±4.4)°, respectively. The incidence of posterior wall fracture was 89.8%. (2) The Visual Analogue Scale and Oswestry Disability Index were significantly correlated with vertebral instability (r=0.33, P < 0.001; r=0.53, P < 0.001), but had weak correlation with local kyphosis angle (r=-0.16, P=0.03; r=-0.16, P=0.03). (3) The incidence of vertebral instability in patients with delayed neurologic deficit was significantly higher than that in patients without delayed neurologic deficit (P < 0.001), but there was no difference in local kyphosis angle between two groups (P=0.18). All patients with delayed neurologic deficit had posterior wall fracture, but only 2/3 patients with posterior wall fracture had delayed neurologic deficit. (4) In summary, vertebral instability is one of the factors leading to clinical symptoms of osteoporotic vertebral fracture patients with intravertebral clefts. The vertebral instability may be the main cause of delayed neurologic deficit. In order to treat back pain and delayed neurologic deficit effectively, it is important to control vertebral instability of osteoporotic vertebral fracture patients with intravertebral clefts.