J Korean Fract Soc.  2008 Oct;21(4):304-311. 10.12671/jkfs.2008.21.4.304.

The Relationship between Progression of Body Collapse and MRI Findings in Osteoporotic Stable Thoracolumbar Fractures

• Koh YD
• Yoon JS
• Hwang JY
• Park HS

• KMID: 1480920
• DOI: http://doi.org/10.12671/jkfs.2008.21.4.304

Abstract

PURPOSE: To find out the relationship between the initial Magnetic Resonance Image (MRI) findings and the progression of vertebra collapse when treated with Jewett brace in osteoporotic stable thoracolumbar fractures.
MATERIALS AND METHODS
We divided 38 cases of 37 patients of thoracolumbar osteoporotic stable thoracolumbar fractures who were treated with Jewett brace into two groups. One group was composed of those body collapse progressed more than 10% compared with the initial state, and the other group less than 10%. We analyzed the relationships between the progression of collapse and the superior endplate fractures, the fracture line extending to posterior cortex, the size of bone marrow edema, the signal intensity on T1 and T2 weighted MR images, the presence of paravertebral hematoma, and the degree of posterior extensor muscle atrophy using MR images.
RESULTS
The body collapse was more likely to progress when there was superior endplate fracture, when it showed larger size of bone marrow edema on T1 weighted image, and transverse low signal on T2 weighted image. But extending of fracture line to posterior cortex, presence of paravertebral hematoma, and degree of posterior extensor muscle atrophy did not show any statistical correlations to progression of collapse.
CONCLUSION
The body collapse is more likely to progress when there was superior endplate fracture, larger low signal on T1 weighted image and low signal on T2 weighted image at initial MRI treated with Jewett brace.

Keyword

Thoracolumbar spine; Stable vertebral fractures; Osteoporosis; Progression of compression; MRI; Jewett brace

MeSH Terms

Bone Marrow
Braces
Edema
Hematoma
Humans
Magnetic Resonance Spectroscopy
Muscular Atrophy
Osteoporosis
Spine

Figure

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  Fig. 1 Size of bone marrow edema on T1-weighted image. (A) Grade 1 is less than 25%. (B) Grade 2 is between 25~50%. (C) Grade 3 is between 50~75%. (D) Grade 4 is beyond 75%.

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  Fig. 2 Classification of paravertebral muscle atropy accoding to Goutallier classification.

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  Fig. 3 Thoracolumbar vertebra height were reported as fractions of referent height. Thoracolumbar vertebra height (%)=2Hf / (Hs+Hi) *100. Compression ratio = 1-thoracolumbar vertebra height (%).

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  Fig. 4 Progression of compression of whole patient in relation to follow up period.

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  Fig. 5 (A) Initial plain radiogragh. (B, C) CT sagittal image and sagittal T2-weighted image, an superior endplate fracture line is found, but the fracture line which extends to the posterior cortex is not found. (D) On the plain radiograph after 6 months, there is a progression of height loss of the fractured body compared with initial film.

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  Fig. 6 L1 vertebral body fracture with fracture line involved to the posterior cortex. At 10 month follow up, the compression progress is 8% noted.

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  Fig. 7 (A) Initial plain radiograph of L1 fracture. (B) Intermediate to low signal intensity line on T2 weighted image. (C) On the plain radiograph taken after 6 months, there is an additional 30% height loss compared with the initial film.

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  Fig. 8 (A) On sagittal multiplanar reconstruction image of Modified discrete cosine transform multidetector computed tomography (MDCT), there is transverse low density at a thoracolumbar vertebra, which is supposed to be a defect of cancellous bone (white arrow). (B) On T2 weighted MR image, intermediate to low signal intensity line (white arrow) is corresponds to the low density of MDCT image.

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