胸侧位像椎体压缩骨折诊断忽视原因浅析

目的 试分析常规X线胸像椎体压缩骨折诊断忽视的原因.方法 回顾分析1638例住院治疗患者的X线胸正侧位影像.年龄范围从50～91岁,平均(64±9)岁,其中男871例,女767例.所有患者的主诉或申请X线胸像检查的原因均与骨质疏松症和骨折无关.椎体压缩及分度的判定及分度方法选用Genant半定量(semiquantitative)目测法,椎体压缩骨折Ⅰ、Ⅱ、Ⅲ度的标准分别为椎体高度约减低20%～25%(Ⅰ度)、26%～40%(Ⅱ度)及41%以上(Ⅲ度),将椎体压缩骨折的影像评阅的结果与其既往X线报告结果和相应出院后病历记录进行比较分析.结果 1638例胸侧位影像评阅结果显示,椎体压缩骨折患者84例,压缩骨折的椎体总数为100个,其中X线影像报告已诊断为压缩骨折者共30例,X线影像报告未诊断的患者有54例.30例已诊断为椎体压缩骨折的X线影像报告中均未进行椎体压缩骨折的分度诊断.54例患者X线报告未诊断椎体压缩骨折63个,其中单发椎体压缩骨折47个,占X线报告未诊断椎体压缩骨折的75%;X线报告未诊断的Ⅰ度椎体压缩骨折34个(54%),Ⅱ度骨折21个(33%),而Ⅲ度骨折仅8个(13%).84例椎体压缩骨折患者中,行双能X线骨密度测量者仅有5例(6%),出院诊断椎体压缩骨折者仅有5例(6%),而出院带治疗骨质疏松症药物者也仅有15例(18%).15例带药患者所带与骨质疏松症治疗有关的药物均为钙类制剂.结论 无论影像科还是其他科室的医师均应增强对骨质疏松症的全面认识,对患者X线胸像侧位片所示的椎体骨质疏松性压缩骨折应做出及时、完整的影像诊断,并予规范化的防治和干预.     

椎体压缩性骨折PVP术后再发骨折危险因素的研究进展

随着我国人口老年化的情况日益严重,骨质疏松性疾病的患者也越来越多,骨质疏松性椎体压缩性骨折(OVCF)成为目前的主要问题之一.越来越多的患者首选经皮椎体成形术(PVP)治疗,随之术后椎体再发骨折的病例也逐渐增多,椎体压缩性骨折PVP术后再发骨折被越来越多的人所重视.为了降低椎体再发骨折的发生率,需要对椎体再发骨折的危险因素深入研究及探索.本文将对椎体压缩性骨折PVP术后再发骨折的危险因素作一综述.     

Successful treatment of a chronic post-traumatic 5-year-old osteoporotic vertebral compression fracture by percutaneous vertebroplasty

Osteoporotic vertebral compression fracture (VCF) is a frequently encountered clinical problem associated with chronic pain and disability. Conservative treatment in the form of bed rest, pain control and bracing may create a vicious circle, in which reduced activity leads to further reduction in bone density and fracture risk. Percutaneous vertebroplasty (PVP) is an accepted treatment modality for osteoporotic vertebral body collapse present for less than 1 year, vertebral myeloma, haemangioma, metastasis and recent traumatic fractures (between 3 and 12 months). We describe an osteoporotic patient in whom successful PVP was performed, under general anaesthesia using CT and fluoroscopic guidance, in a post-traumatic 5-year-old VCF with complete alleviation of debilitating pain. In the light of our experience, we suggest that PVP should be carried out in a series of similar patients to asses its value as a treatment option in patients with chronic osteoporotic vertebral fractures for pain relief and improvement in mobility, independent of fracture age.     

New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women

BACKGROUND AND PURPOSE: Percutaneous vertebroplasty has been performed in the United States in an increasing volume since the mid-1990s. The purpose of this study is to analyze the risk of a new symptomatic vertebral compression fractures within 1 year of having an acute/subacute fracture treated with vertebroplasty. METHODS: A retrospective analysis was performed in which 253 female patients were found to have acute/subacute vertebral compression fractures secondary to osteoporosis treated with percutaneous vertebroplasty. Occurrences of new symptomatic vertebral compression fractures were recorded for a year following initial vertebroplasty. RESULTS: Fifty-five patients (21.7%) of the 253 osteoporotic women with one or more initial fractures experienced a new symptomatic vertebral compression fracture within 1 year. CONCLUSION: Roughly one-fifth of osteoporotic women with acute/subacute fracture treated with vertebroplasty will have a subsequent fracture within 1 year.     

Vertebral morphometry: evaluation of osteoporosis-caused fractures

PURPOSE: To compare visual reading of spine radiographs and quantitative morphometric approach for assessing the prevalence of vertebral fractures in postmenopausal osteoporosis. MATERIAL AND METHODS: In 473 postmenopausal women afferent to our Centre of Osteoporosis under-went lateral thoracic and lumbar spine radiograph to identify vertebral fractures and dual energy X-ray absorptiometry (DXA) to measure bone mineral density (BMD) of the lumbar spine (L1-L4). Osteoporosis was defined according to the World Health Organization (WHO) guidelines. To identify vertebral fractures the radiographs were visually analyzed by two radiologists; a woman was judged as fractured only if both readers independently found at least one vertebral fracture on her films. Then the spine radiographs were digitized by means of a scanner to perform quantitative vertebral morphometry (QVM) using specific software. An expert operator manually located the calipers on the vertebral bodies from T4 to L5 and the computer automatically calculated the anterior, middle and posterior vertebral heights and their ratios. A vertebral fracture was defined by morphometry as a reduction by at least 20%, with an absolute decrease of at least 4 mm, in one of three height ratios of any vertebral body compared to the corresponding reference ratio for fertile women. RESULTS: Visual reading by radiologists detected 9.5% (45/473) women with vertebral fractures and QVM detected 13.7% (65/473) with statistical significance (p < 0.001). In the 75-80 years age group the prevalence of vertebral fractures reaches the maximum value, 26.3% by visual reading and 36.8% by QVM. Among fractured women, 34 were osteoporotic by DXA; 11 women found fractured by visual reading and 21 by QVM were osteopenic women, with bone mineral densities between -1 and -2.5 SD of the T-score. CONCLUSION: This study showed that quantitative assessment of spine radiographs by vertebral morphometry is an objective method that allows to identify a larger number of vertebral fractures compared to visual inspection. This is very important not only for epidemiological studies, but also for clinical use because a previous vertebral fracture increases the risk of subsequent fractures significantly. Therefore, to improve the risk assessment of vertebral fractures for osteoporotic patients it is necessary to combine the use of QVM and BMD.     

Subsequent vertebral fractures after vertebroplasty: association with intraosseous clefts

BACKGROUND AND PURPOSE: Patients with vertebral fractures containing intraosseous clefts may represent a distinct subgroup of vertebroplasty patients, yet the development of subsequent vertebral fractures in this population has not been explored. We tested the hypothesis that after vertebroplasty for intraosseous clefts, subsequent fractures would occur earlier and more frequently than after treatment of non-cleft-containing fractures. METHODS: We retrospectively reviewed 362 patients treated with vertebroplasty for osteoporotic fractures. The location, frequency, and timing of subsequent fractures were compared between 2 subgroups: group 1, patients treated at fractures containing clefts, and group 2, treated patients without clefts. A vertebra-by-vertebra analysis was used to compare the relative risk and timing of subsequent fractures adjacent to vertebrae with or without clefts. RESULTS: Group 1 included 63 patients treated at 65 vertebrae and group 2 included 250 patients treated at 399 vertebrae. Group 1 demonstrated a nearly twofold increased risk of subsequent fracture (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.04-3.49, P = .037). At the vertebral level, the relative risk of subsequent fracture was 2.02 (95% CI, 1.46-2.58; P = .013) times greater adjacent to a treated cleft. Fractures adjacent to any treated level occurred significantly sooner than nonadjacent fracture (P = .0004). The presence of a cleft was not significantly associated with the timing of subsequent fractures. CONCLUSIONS: Patients with osteoporotic vertebral fractures containing clefts are at increased risk for subsequent fractures and treatment of these clefts is associated with increased rates of adjacent fracture. There is no significant difference in the timing of subsequent fractures based on the presence of a cleft.     

Determination of vertebral fracture threshold by measuring bone mineral content in the lumbar vertebrae]

Bone mineral density (BMD) in the lumbar vertebrae (L2-L4) was assessed by dual energy X-ray absorptiometry (DEXA: QDR-1000), and the values obtained were compared with the frequency of vertebral fracture as assessed by spinal X-ray photographs. Patients with spondylosis or scoliosis, which affect BMD values, were excluded from the study. An essentially linear correlation was observed between the frequency of vertebral fracture and lumbar BMD values: no vertebral fractures were observed in those whose BMD more than 0.8 g/cm2, whereas the frequency of fracture was 100% in patients whose BMD was less than 0.45 g/cm2. Thus, measurement of lumbar vertebrae by DEXA would be very useful in predicting vertebral fractures.     

Vertebroplasty in patients with severe vertebral compression fractures: a technical report

Vertebroplasty is a procedure in which polymethlymethacrylate (PMMA) is injected into a vertebral body compression fracture. It has been suggested that fractues greater than 65% to 70% of the original vertebral body height are too compressed to be treated successfully with this procedure. We describe six patients with severe compression fractures that were successfully treated with vertebroplasty in which the trocar was inserted in the far lateral aspect of the vertebral body, because of the typical morphology of severe compression fractures.     

Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body

BACKGROUND AND PURPOSE: Patients successfully treated with vertebroplasty often return with new pain caused by a new vertebral body fracture. The new fractures often are adjacent to the vertebral bodies that were initially treated. In our clinical work, we have observed that cement leakage into the disk increases the risk of new fracture of the adjacent vertebral body. This study analyzed the risk of new fractures of adjacent vertebral bodies in relationship to cement leakage into the disk. METHODS: This study was based on 38 patients with painful compression fractures treated with vertebroplasty. Patients who returned with new pain after initial successful vertebroplasty were evaluated by repeat MR imaging. We analyzed the incidence of new fractures of adjacent vertebral bodies in relationship to cement leakage into the disk that had occurred during the initial vertebroplasty. RESULTS: Fourteen patients developed new fractures during the follow-up period. In 10 patients, the new fractures were associated with cement leakage into the disk, whereas four patients had new fractures that were not associated with cement leakage into the disk. This difference was statistically significant (P =.018). A detailed analysis showed that 58% of vertebral bodies adjacent to a disk with cement leakage fractured during the follow-up period compared with 12% of vertebral bodies adjacent to a disk without cement leakage (P <.0005). CONCLUSION: Leakage of cement into the disk during vertebroplasty increases the risk of a new fracture of adjacent vertebral bodies.     

MRI对椎体骨折的诊断价值

目的:探讨MRI对椎体压缩性(陈旧与新鲜)和隐匿性骨折的诊断价值。方法:对34例椎体骨折于初诊及伤后3,6,12个月行脊柱MRI检查,分析其信号改变与临床的关系。结果:37个骨折椎体急性期均表现为T1WI低信号、T2WI高信号,伤后3和6个月时分别有7个(18.9%)和22个骨折椎体(59.5%)恢复正常,12个月时全部恢复正常信号。伤后不同时期MRI检查结果相差十分显著。6个椎体陈旧骨折,与正常椎体信号无差别。8个隐匿性骨折椎体形态无异常,MRI T1WI、T2WI示椎体内横行条状低信号,3个月复查50%恢复正常,6个月复查基本恢复正常。结论:MRI能判断骨折修复的不同时期,鉴别椎体陈旧与新鲜骨折,尤其是存在多个椎体变形时则更具诊断价值;MRI检查对隐匿性骨折敏感。     

A careful evaluation of scout CT lateral radiograph may prevent unreported vertebral fractures

Objectives

Our purpose was to review scout CT lateral radiographs to reveal osteoporotic vertebral fractures unreported by radiologists and to explore scout CT as a potential diagnostic tool in the detection of vertebral fractures.

Methods

We considered 500 patients (303 males, 197 females, age 64.6 ± 13.5 year-old). Our investigation was firstly focused on scout CT lateral images to detect vertebral fractures with a combined semiquantitative and quantitative diagnostic approach. Findings addressed to vertebral fracture were subsequently confirmed by multiplanar sagittal CT reconstructions. Whenever a vertebral fracture was discovered the radiologist report was read and a collection of patient anamnesis followed to understand whether fractures were already known.

Results

In 44/500 patients (8.8%) the evaluation on scout CT was incomplete or limited for patient/technical-based conditions, and 15 were excluded from the analysis. In 67/485 patients (13.8%) 99 vertebral fractures were detected. Among 67 fractured patients only 18 (26.9%) were previously diagnosed by radiologists. However, in the clinical history of 32 patients vertebral fractures were already known.

Conclusions

The perception and sensibility to vertebral fractures among radiologists are still poor when the assessment of the spine is not the aim of the examination. Short time spent for the evaluation of scout CT lateral radiographs could improve our accuracy.     

Differences in proximal femur geometry distinguish vertebral from femoral neck fractures in osteoporotic women

Bone mineral density (BMD) is generally used to predict the risk of fracture in osteoporotic subjects. However, femoral neck BMD and spine BMD have been reported not to be significantly different among patients with hip or vertebral fractures, suggesting that other risk factors are needed to determine the different fracture types. Proximal femur geometry (PFG) parameters, such as hip axis length (HAL), femoral neck-shaft angle (NSA) and femoral neck diameter (FND) have also been shown to predict the risk of hip fracture. These parameters are statistically different in spine fractures compared with both types of hip fractures (trochanteric and femoral neck) when considered together. We wanted to assess the difference in these parameters by comparing spine fractures with a homogeneous group of hip fractures, i.e. femoral neck fractures. 807 post-menopausal women were divided into three groups; those with vertebral fractures (182), those with femoral neck fractures (134) and a control group without fractures (491). Dual X-ray absorptiometry (DXA) scans of the spine and hip were carried out to measure BMD and define the PFG parameters of the hip. Data were statistically analysed. In agreement with other authors, we found that women with femoral neck fractures had longer HAL, wider FND and larger NSA than controls, whereas there were no statistically significant differences in PFG between women with spine fractures and controls. Logistic regression showed HAL and NSA could predict the risk of femoral neck but not vertebral fracture. These data indicate specificity of some PFG parameters for hip fracture risk.     

绝经期女性胸腰椎后凸与椎体压缩骨折相关性分析

目的探讨绝经期女性骨质疏松骨折的临床特点,以及胸腰段脊柱力线对骨折发生的风险分析。方法本研究为病例对照研究,收集自2013年1月至2015年6月因骨质疏松性压缩骨折在北京积水潭医院住院,并行椎体成形术的绝经期女性患者396例(研究组),平均年龄64岁(55~72岁);对照组选取因下腰椎退行性疾病住院手术的患者271例,平均年龄62岁(55~84岁)。记录所有患者入院时的年龄、体质量指数(BMI)、骨密度定量CT(QCT)、骨折椎体。利用站立位X线影像测量胸腰段(T11~L2)矢状位和冠状位的Cobb角。利用患者胸腰段椎体的平均Cobb角,修订并推算骨折前患者T11~L2的矢状位和冠状位Cobb角。分析胸腰段骨质疏松性骨折的临床点和危险因素。结果研究组患者中,T11椎体骨折患者69例(19.6%),T12椎体骨折153例(43.5%),L1椎体骨折174例(49.4%),L2椎体骨折70例(19.9%)。研究组和对照组患者的年龄和BMI差异无统计学意义(P>0.05)。研究组患者修订后的胸腰段矢状位Cobb角为(13.6°±7.6°),对照组为(5.9°±6.0°),两组间差异有统计学意义(P<0.01)。研究组患者修订后胸腰段冠状位Cobb角为(0.4°±4.0°),对照组为(0.1°±4.1°),两组间差异无统计学意义(P>0.05)。使用ROC曲线和尤登指数计算胸腰段矢状位Cobb角,对于胸腰椎骨质疏松性骨折的最佳分界值为7.5°,OR值为7.6(95%可信区间为2.5~22.8)。结论胸腰段矢状位后凸会增加骨质疏松性骨折的风险,后凸Cobb角度>7.5°时,骨折风险增加7倍,但冠状位的侧弯不增加骨折的风险。     

Combined Vertebral Fracture Assessment and Bone Mineral Density Measurement: A Patient-friendly New Tool with an Important Impact on the Canadian Risk Fracture Classification

Purpose

Vertebral fractures often go unnoticed, while they constitute a significant risk factor for new fractures, independent of the bone density. Vertebral Fracture Assessment (VFA) is a new feature on DXA bone densitometry equipment. Our purpose was to determine the added value of VFA and its impact on the Canadian fracture risk classification using data from a Dutch academic cohort.

Methods

All 958 consecutive patients (64% female, mean age 53 [20–94], mean weight 75 kg [32–150]) who underwent BMD measurement at the University Medical Center Groningen, The Netherlands also underwent VFA in the same session.

Results

The prevalence of vertebral fractures was 26%. In 68% of these patients this fracture was unknown. The severity was “mild” (20%–25% height loss) in 43%, “moderate” (25%–35%) in 44% and “severe” (>35% height loss) in 13%. Even after excluding mild fractures, the prevalence of vertebral fractures was 17%. In the 28% with normal BMD the vertebral fracture prevalence was still 18%, in the 43% with osteopenia 23%, and in the 29% with osteoporosis 36%. The Canadian risk classification was “low fracture risk” in 68%, “moderate” in 19%, and “high” in 13%. Adding VFA altered the classification in 20% of the patients, to become 54%, 27%, and 19%, respectively.

Conclusions

VFA added to BMD is a patient friendly diagnostic tool with a high diagnostic yield, as it detected unknown vertebral fractures and altered diagnostic classification in approximately 1 out of every 5 patients. These results suggest that BMD plus VFA may become the new standard in osteoporosis testing.     

Epidemiology of vertebral fractures: implications for vertebral augmentation

To put vertebral augmentation (eg, vertebroplasty) into perspective, the etiology and outcomes of vertebral fractures are reviewed. There is considerable debate about which criteria should be used to define a vertebral fracture because there is no consistent relation between symptoms and the degree of vertebral deformity. However, it is the more significant vertebral body deformities that are most closely associated with frequent or severe back pain, and the referrals for vertebral augmentation come mainly from this subset of patients. In addition to their vertebral fractures, these patients typically have osteoporosis or elevated bone turnover, and they are at greatly increased risk of subsequent fractures as a result of falling or, more often, excessive spinal loads from activities of everyday living. Additional risk factors for new vertebral fractures include the number and severity of vertebral deformities at baseline. Moreover, new fractures are most likely in nearby vertebrae, and they occur more frequently in the mid-thoracic or thoracolumbar regions of the spine. Interestingly, these are also the characteristics of the subsequent fractures of contiguous vertebrae considered by some to represent a complication of vertebral augmentation, yet they characterize vertebral fracture risk even in untreated patients. Vertebral fractures are very common among older men and postmenopausal women; they are associated with substantial morbidity and mortality; and they may have a devastating impact on the patient's quality of life. Vertebral augmentation may be able to help many of these patients, although opportunities exist to optimize management strategies with respect to the other factors that influence long-term outcomes in this patient population.     

Incidence of adjacent vertebral fractures in patients treated with balloon kyphoplasty: two years' prospective follow-up

PURPOSE: To evaluate the long-term outcomes of 37 patients with 60 osteoporotic vertebral fractures, located in the thoracic and lumbar spine, treated with balloon kyphoplasty. MATERIAL AND METHODS: Fourty-two patients (15 males and 27 females) with 67 osteoporotic vertebral fractures were treated with balloon kyphoplasty. We were able to have 2-year follow-up of 37 patients with 60 treated vertebrae. Baseline fracture rate in these 37 patients was 1.9 (60 fresh fractures and 11 old fractures already healed). Symptomatic levels were identified by correlating the clinical presentation with conventional radiographs, computed tomography (CT), and/or magnetic resonance imaging (MRI). During the 2-year follow-up, reduction in pain was determined. The effects on pain symptoms were measured on a self-reported visual analog scale (VAS) and the Oswestry score was documented to assess disability. Radiographic scans were performed pre- and postoperatively, and after 3, 6, 12, and 24 months. The vertebral height and endplate angles were measured to assess the restoration of the sagittal alignment. RESULTS: The median pain scores (VAS) decreased significantly from pre- to post-treatment as did the Oswestry Disability Score (P<0.05). This improvement was maintained at 2-year follow-up. In eight patients (21.6%) (five female, three male), an adjacent fracture occurred in 11 vertebrae (18.3%) within 3 weeks to 22 months of follow-up (after 22 months no adjacent fracture occurred). This makes an annualized refracture rate of 10% (18.3/22 x 12). In three patients the adjacent fractures were asymptomatic. Five patients with symptomatic adjacent fractures (eight vertebrae) wanted to be treated again with balloon kyphoplasty. Clinically asymptomatic cement leakage occurred in nine of 67 vertebral bodies (13.4%). During 2-year follow-up, this surgical technique demonstrated restoration and stabilization of the height of the vertebral body. CONCLUSION: Balloon kyphoplasty is an effective, minimally invasive procedure for the stabilization of osteoporotic vertebral fractures, leading to a statistically significant reduction of pain status.     

The posterior vertebral body line: importance in the detection of burst fractures

A review of the lateral radiographs and CT studies of 114 patients with burst fractures, 46 patients with combined injuries in whom bursting was a major component, and 82 patients with simple anterior compression fractures was performed to evaluate the integrity of the posterior vertebral body margin. This structure normally produces a single or bifid vertical line on the lateral radiograph. Disruption, displacement, or rotation of this line was found in all 114 patients with "pure" burst fractures. These abnormalities were also present in 36 of the 46 patients with combined burst injuries. In all patients with simple compression fracture, flexion, distraction or dislocation, and extension injuries, the line was normal. CT studies showed these abnormalities to be the result of retropulsion of one or more bone fragments from the posterior margin of the vertebral body. Disruptive abnormalities of the posterior vertebral body line are reliable plain-film signs that a burst fracture has occurred and that compromise of the vertebral canal and subarachnoid space is present.     

Recognizing and reporting vertebral fractures: reducing the risk of future osteoporotic fractures.

OBJECTIVE: Given the increasing evidence that vertebral fractures are underdiagnosed and not acted on, Osteoporosis Canada and the Canadian Association of Radiologists initiated a project to develop and publish a set of recommendations to promote and facilitate the diagnosis and reporting of vertebral fractures. OPTIONS: The identification of spinal fractures is not uniform. More than 65% of vertebral fractures cause no symptoms. It is also apparent that vertebral fractures are inadequately recognized when the opportunity for diagnosis arises fortuitously. It is to patients' benefit that radiologists report vertebral fractures evident on a chest or other radiograph, no matter how incidental to the immediate clinical indication for the examination. OUTCOMES: The present recommendations can help to close the gap in care in recognizing and treating vertebral fractures, to prevent future fractures and thus reduce the burden of osteoporosis-related morbidity and mortality, as well as fracture-related costs to the health care system. EVIDENCE: Several studies indicate that a gap exists in regard to the diagnosis of vertebral fractures and the clinical response following such diagnosis. All recommendations presented here are based on consensus. VALUES: These recommendations were developed by a multidisciplinary working group under the auspices of the Scientific Advisory Council of Osteoporosis Canada and the Canadian Association of Radiologists. BENEFITS, HARM, AND COSTS: Prevalent vertebral fractures have important clinical implications in terms of future fracture risk. Recognizing and reporting fractures incidental to radiologic examinations done for other reasons has the potential to reduce health care costs by initiating further steps in osteoporosis diagnosis and appropriate therapy. RECOMMENDATIONS: Physicians should be aware of the importance of vertebral fracture diagnosis in assessing future osteoporotic fracture risk. Vertebral fractures incidental to radiologic examinations done for other reasons should be identified and reported. Vertebral fractures should be assessed from lateral spinal or chest radiographs according to the semiquantitative method of Genant and colleagues. Grade II and Grade III fractures as classified by this method should be given the greatest emphasis. Semiquantitative fracture recognition should include the recognition of changes such as loss of vertebral end-plate parallelism, cortical interruptions, and quantitative changes in the anterior, midbody, and posterior heights of vertebral bodies. When spine radiographs are performed to assess the presence of vertebral fractures, anteroposterior examinations may assist in the initial evaluation. The standard follow-up need only consist of single lateral views of the thoracic and lumbar spine that include T4 to L4 vertebrae. The radiographic technique described in this paper, or a technique of comparable efficacy, should be used. Dual X-ray absorptiometry examinations that include lateral spinal morphological assessments (vertebral fracture assessment) may contribute to fracture recognition. Educational material about the clinical importance of vertebral fracture recognition as a potential indicator of future osteoporotic fracture risk with its associated morbidity and mortality should be directed to all physicians. VALIDATION: Recommendations were based on consensus opinion.     

New symptomatic compression fracture after percutaneous vertebroplasty at the thoracolumbar junction

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the risk factors for new symptomatic vertebral compression fractures after vertebroplasty at the thoracolumbar junction. MATERIALS AND METHODS: We conducted a retrospective analysis of 53 patients treated with percutaneous vertebroplasty at the thoracolumbar junction (T12, L1). The follow-up period was 15-27 months. The occurrence of new symptomatic vertebral compression fractures was recorded after vertebroplasty. We evaluated patient age and sex, amount of injected cement, vacuum clefts in the collapsed bodies, initial wedge angle of the compression fracture, change of the wedge angle after vertebroplasty, intradiskal cement leak, and percentage of height restoration of the vertebral body. In this report, we surveyed the possible risk factors for new symptomatic vertebral compression fractures. RESULTS: Thirty-nine (74%) of the 53 patients had fluid and/or air in the compression fracture at the thoracolumbar junction (T12, L1). Eight (20.5%) of the 39 patients with vacuum clefts had new symptomatic compression fracture after vertebroplasty between 1 month and 4 days after surgery to 23 months and 4 days after surgery. The patients with new symptomatic compression fracture had higher initial wedge angle and wedge angle change (more than 7 degrees ) after vertebroplasty than those without fractures; these data were considered statistically significant. CONCLUSIONS: The incidence of vacuum clefts in the compression fracture at the thoracolumbar junction is high (74%). The severity of initial wedge angle and wedge angle change affects the incidence of new symptomatic compression fracture.     

Underreporting of vertebral fractures on routine chest radiography

OBJECTIVE: Osteoporosis is underdiagnosed and therefore undertreated. We determined the potential usefulness of chest radiography for detecting clinically important vertebral fractures by performing semiquantitative reviews and quantitative digital morphometry on 100 routine chest radiographs taken in the emergency department and comparing the yield of these independent reviews with official radiology reports. MATERIALS AND METHODS: One hundred randomly selected chest radiographs of patients 60 years or older who presented to the emergency department of a tertiary care hospital were evaluated. Radiographs were selected without knowledge of the presenting complaint and were independently reviewed by two board-certified radiologists and a radiology resident. A validated semiquantitative method was used to assess lateral chest radiographs for vertebral fracture. In addition, quantitative digital morphometry was undertaken. A clinically important vertebral fracture was defined as one that was at least moderate to severe (loss of height >or=> 25%). RESULTS: Mean age of the population was 75 years, 47% were women, and 46% were admitted to the hospital. According to the reference radiologist, prevalence of moderate to severe vertebral fractures was 22%. Simple agreement was 87-88% among reviewers; kappa values were moderate (0.56-0.58). The greatest agreement was between the reference standard radiologist and quantitative digital morphometry (89% agreement; kappa = 0.67). Only 55% (12/22) of vertebral fractures we identified were mentioned in the official radiology reports. CONCLUSION: Chest radiography has potential as a screening tool for revealing previously undiagnosed vertebral fractures, although in this study only half of moderate to severe fractures that we identified were mentioned in official reports.