Changes in the disc space after fractures of the thoracolumbar spine

Oner, F. Cumhur; Rijt, R. R. van der; Ramos, L. M. P.; Dhert, W.J.A.; Verbout, Abraham J.

doi:10.1302/0301-620x.80b5.8830

Cited by 136 publications

(96 citation statements)

References 22 publications

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“…This structure, with high expansive capacity, may creep into the defects in the endplate and expand itself into the vertebral body. Clinical observations support the hypothesis that this may be an important mechanism for explanation of the changes observed in the disc space after a fracture [18]. Another mechanism may be a rapid disc degeneration initiated by an annular tear.…”

Section: Discussionsupporting

confidence: 71%

“…Finally, even if there is no change in the biological integrity of the disc, the changed morphology of the disc space as a result of the fracture of the vertebral body may alter its properties of resisting compressive forces. In a retrospective MRI study, Oner et al showed that all these different mechanisms may lead to different types of post-traumatic disc space changes, with possible consequences for the long-term stability of the injured segment [18]. The question of whether these different mechanisms can be predicted from patterns of injury detected with MRI should be studied in a prospective fashion.…”

Section: Discussionmentioning

confidence: 99%

“…The bony part in a vertebral fracture usually heals completely and returns to normal strength, but the healing of the relatively avascular disc is unpredictable and may depend on the pattern of injury sustained [13,18]. This may partly explain the variations in the results of conservative treatment and the differences in failure rates of posterior fixation reported in the literature [3-7, 15-17, 22-25].…”

Section: Introductionmentioning

confidence: 99%

“…A biomechanical study showed that about 60% of the acute hypermobility after a compression-type fracture is situated in the surrounding discs [13]. Thus the failing disc may be a major contributor to chronic instability [13,18]. The patterns of injury and healing of the discs are largely unknown.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Correlation of MR images of disc injuries with anatomic sections in experimental thoracolumbar spine fractures

Oner¹,

Rijt²,

Ramos³

et al. 1999

European Spine Journal

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Correlation of MR images of disc injuries with anatomic sections in experimental thoracolumbar spine fractures

Oner¹,

Rijt²,

Ramos³

et al. 1999

European Spine Journal

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“…MRI analysis of the disc signal have showed no significant signal intensity modification, and more particularly, no degeneration process. According to Oner [2], the disc changes are the consequences of adaptation to the morphological changes of the end plate with settling of the end-plate defect. Indirect reduction does not allow restoration of the mechanical properties of the end plate-disc interface.…”

mentioning

confidence: 99%

Letter to the Chief Editor: Outcome of thoracolumbar burst fractures treated with indirect reduction and fixation without fusion. Huilin Yang, Jin-hui Shi, Molly Ebraheim, Xiaochen Liu, Joseph Konrad, Ibrahim Husain, Tian-si Tang, Jiayong Liu Eur Spine J. Published online 8 August 2010

Lucas

Emery

2011

Eur Spine J

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We read with great interest the article written by Liu et al. This retrospective study included patients with type A or C according AO classification non-osteoporosis thoracolumbar fractures. They were treated with posterior fixation without fusion after indirect reduction. Almost all patients had instrumentation removal at 9-12 months post-operative. The authors report good long-term outcome for the great majority of included patients.However, the authors report adjacent disc injury and disc degeneration after implants removal without clinical deterioration.According to Roaf [5], the intervertebral disc is always stronger than the vertebral end plate and excessive compression force creates an end-plate fracture. Several animal experimental studies have shown that end-plate fracture can occur when there is pressurization of the nucleus [1]. These studies allow us to hypothesize that human vertebral end-plate fractures are due to excessive nucleus pressurization when brutal compressive loading is transmitted. In this context, disc-end plate interface restoration seems to be one of the main objectives in compressive fractures (type A of Magerl classification) treatment.Disc height loss leading to kyphosis is the main complication of vertebral fractures. MRI analysis of the disc signal have showed no significant signal intensity modification, and more particularly, no degeneration process. According to Oner [2], the disc changes are the consequences of adaptation to the morphological changes of the end plate with settling of the end-plate defect. Indirect reduction does not allow restoration of the mechanical properties of the end plate-disc interface. Moreover, pedicle screw instrumentation does not prevent recurrent kyphosis, particularly with short arthrodesis (one level above, one level below) [3].In our point of view, disc height loss is not a disc degenerative process but an adaptation to new mechanical conditions. Vertebroplasty [4] allows to improve the vertebral body mechanical quality, particularly at the disc-end plate interface. Therefore, this technique seems to prevent disc height loss and recurrent kyphosis.

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Biomechanics of the aging spine

Ferguson

Steffen

The Aging Spine

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IntroductionThe vertebral column is built from alternating bony vertebrae, interconnected with fibrocartilagenous discs and diarthrodial facet joints. In total 33 vertebrae (7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 4 coccygeal) all conform to a basic plan. With the exception of the atlas and axis, all vertebra are made of an anterior approximately cylindrical vertebral body and an arch composed of paired pedicles and laminae, the latter joined posteriorly forming the spinous process. The arch on either side also features a transverse process, as well as superior and inferior articular processes forming corresponding synovial joints (called Abstract The human spine is composed of highly specific tissues and structures, which together provide the extensive range of motion and considerable load carrying capacity required for the physical activities of daily life. Alterations to the form and composition of the individual structures of the spine with increasing age can increase the risk of injury and can have a profound influence on the quality of life. Cancellous bone forms the structural framework of the vertebral body. Individual trabeculae are oriented along the paths of principal forces and play a crucial role in the transfer of the predominantly compressive forces along the spine. Agerelated changes to the cancellous core of the vertebra includes a loss of bone mineral density, as well as morphological changes including trabecular thinning, increased intratrabecular spacing, and loss of connectivity between trabeculae. Material and morphological changes may lead to an increased risk of vertebral fracture. The vertebral endplate serves the dual role of containing the adjacent disc and evenly distributing applied loads to the underlying cancellous bone and the cortex of the vertebra. With aging, thinning of the endplate, and loss of bone mineral density increases the risk of endplate fracture. Ossification of the endplate may have consequences for the nutritional supply and hydration of the intervertebral disc. The healthy intervertebral disc provides mobility to the spine and transfers load via hydrostatic pressurization of the hydrated nucleus pulposus. Changes to the tissue properties of the disc, including dehydration and reorganization of the nucleus and stiffening of the annulus fibrosus, markedly alter the mechanics of load transfer in the spine. There is no direct correlation between degenerative changes to the disc and to the adjacent vertebral bodies. Furthermore, advancing age is not the sole factor in the degeneration of the spine. Further study is crucial for understanding the unique biomechanical function of the aging spine.

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Changes in the disc space after fractures of the thoracolumbar spine

Cited by 136 publications

References 22 publications

Correlation of MR images of disc injuries with anatomic sections in experimental thoracolumbar spine fractures

Correlation of MR images of disc injuries with anatomic sections in experimental thoracolumbar spine fractures

Letter to the Chief Editor: Outcome of thoracolumbar burst fractures treated with indirect reduction and fixation without fusion. Huilin Yang, Jin-hui Shi, Molly Ebraheim, Xiaochen Liu, Joseph Konrad, Ibrahim Husain, Tian-si Tang, Jiayong Liu Eur Spine J. Published online 8 August 2010

Biomechanics of the aging spine

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