Characteristic imaging findings predicting the risk of conservative treatment resistance in fresh osteoporotic vertebral fractures with poor prognostic features on magnetic resonance imaging

Funayama, Toru; Tsukanishi, Toshinori; Fujii, Kengo; Abe, Tetsuya; Shibao, Yosuke; Noguchi, Hiroshi; Miura, K.; Mataki, Kentaro; Takahashi, Hiroshi; Koda, Masao; Yamazaki, Masashi

doi:10.1016/j.jos.2021.01.005

Cited by 6 publications

(9 citation statements)

References 21 publications

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“…Previous studies have reported that the risk factors of a delayed union in OVFs are the thoracolumbar junction location, the presence of a posterior wall fracture with displacement, and diffuse low-and high-signal changes on T2-weighted MRI 20,21 . Other studies have reported that VI is involved in conservative resistance in OVFs 11,12 . We believe that cases with severe VI are refractory to conservative treatment, associated with clinical findings, and reflect severity.…”

Section: Discussionmentioning

confidence: 89%

“…CRst = (1 − A1/P1) × 100 and CRsp = (1 − A2/P2) × 100, respectively. VI (%) was defined as the difference in vertebral collapse rates between the standing and supine collapse rates: VI = CRst − CRsp 11,12 .…”

Section: Methodsmentioning

confidence: 99%

“…According to our previous report 12 , we classified patients into a VI of 20%, which was calculated as the threshold value for resistance to conservative treatment. We classified patients into two groups according to the calculated VI: group 1 (VI <20%) and group 2 (VI ≥20%).…”

Section: Methodsmentioning

confidence: 99%

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Relationship between Vertebral Instability and the Cross-Sectional Area of Lumbar Muscles in Postmenopausal Acute Osteoporotic Vertebral Fractures

Okuwaki¹,

Funayama

Ikumi³

et al. 2022

Spine Surg Relat Res

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Introduction: Vertebral instability (VI) in osteoporotic vertebral fractures (OVFs) varies from mild to severe. The relationship between the VI of OVFs and independent factors, such as bone mineral density (BMD) and lumbar muscle volume, is unclear. This study aimed to investigate whether BMD and the cross-sectional area (CSA) of lumbar muscles are related to VI in OVFs.Methods: On the basis of the thoracolumbar lateral radiographs of 95 acute OVFs in postmenopausal women (mean age 80.6 years; range: 64-103 years), supine and standing vertebral collapse rates (CRsp and CRst, respectively) were determined. Subsequently, VI was defined as follows: VI = CRst − CRsp.Using axial T2-weighted magnetic resonance imaging (MRI), CSA of the psoas major, erector spinae, and multifidus muscles at the L3/4 intervertebral disc level were measured. The BMD of the lumbar spine and proximal femur (total hip) was measured for all participants using dual-energy X-ray absorptiometry. The patients were classified into group 1 (VI <20%) and group 2 (VI ≥20%). Results:We observed a negative correlation between VI and CSA of the erector spinae muscle (r = −0.3962, P < 0.0001). No significant correlations were observed between VI and BMD. The CSA of the erector spinae muscle in group 2 was significantly lower than that in group 1 (P = 0.0002). No significant difference in the BMD or the CSA of the psoas major or multifidus muscles was observed between the two groups. A multivariable analysis of factors of VI was performed. Both age (odds ratio [OR], 1.099; 95% confidence interval [CI], 1.015-1.189; P = 0.020) and the CSA of the erector spinae (OR, 0.996; 95% CI, 0.993-0.999; P = 0.020) were significant predictors of high VI.Conclusions: Although the severity of OVFs was related to the CSA of the erector spinae muscle, it was not associated with BMD.

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Section: Discussionmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

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Relationship between Vertebral Instability and the Cross-Sectional Area of Lumbar Muscles in Postmenopausal Acute Osteoporotic Vertebral Fractures

Okuwaki¹,

Funayama

Ikumi³

et al. 2022

Spine Surg Relat Res

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“…Lateral dynamic radiographs at the level of the injury were made with the patient standing or sitting (i.e., in a loaded position) and in a supine position (in a non-loaded position) 28 . The vertebral collapse rate (in %) was defined as (1 − [anterior vertebral wall height/posterior vertebral wall height]) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images 9 . The local kyphotic angle (θ) was measured with use of the Cobb method in the vertebral bodies cranial and caudal to the OVF 29 .…”

Section: Methodsmentioning

confidence: 99%

“…One study showed that strict hospitalized bed rest for 2 weeks during the initial stages of conservative treatment yielded favorable results, with bone union being achieved in 79% of patients 21 . Another study showed that 78% of patients with poor prognostic findings on MRI avoided surgery after 2 weeks of hospitalized bed rest 9 . To our knowledge, there has been no published study in which bed rest has been compared with no bed rest for the treatment of patients with OVF.…”

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confidence: 99%

Therapeutic Effects of Conservative Treatment with 2-Week Bed Rest for Osteoporotic Vertebral Fractures

Funayama

Tatsumura

Fujii

et al. 2022

Journal of Bone and Joint Surgery

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UpdateThis article was updated on October 19, 2022, because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 1787, in the legend for Figure 2, the sentence that had read “The vertebral collapse rate (in %) was defined as 1 − (A/P) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images.” now reads “The vertebral collapse rate (in %) was defined as (1 − [A/P]) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images.” On page 1788, in the section entitled “Data Collection,” the sentence that had read “The vertebral collapse rate (in %) was defined as 1 − (anterior vertebral wall height/posterior vertebral wall height) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images9.” now reads “The vertebral collapse rate (in %) was defined as (1 − [anterior vertebral wall height/posterior vertebral wall height]) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images9.” Finally, on page 1791, in Table IV, the footnote for the “Primary outcome” row that had read “N = 113 in the rest group and 99 in the no-rest group.” now reads “N = 116 in the rest group and 108 in the no-rest group.”

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Risk factors affecting vertebral collapse and kyphotic progression in postmenopausal osteoporotic vertebral fractures

et al. 2021

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Characteristic imaging findings predicting the risk of conservative treatment resistance in fresh osteoporotic vertebral fractures with poor prognostic features on magnetic resonance imaging

Cited by 6 publications

References 21 publications

Relationship between Vertebral Instability and the Cross-Sectional Area of Lumbar Muscles in Postmenopausal Acute Osteoporotic Vertebral Fractures

Relationship between Vertebral Instability and the Cross-Sectional Area of Lumbar Muscles in Postmenopausal Acute Osteoporotic Vertebral Fractures

Therapeutic Effects of Conservative Treatment with 2-Week Bed Rest for Osteoporotic Vertebral Fractures

Risk factors affecting vertebral collapse and kyphotic progression in postmenopausal osteoporotic vertebral fractures

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