Characteristic Radiographic or Magnetic Resonance Images of Fresh Osteoporotic Vertebral Fractures Predicting Potential Risk for Nonunion

Abstract

The results of this study revealed significant relationships between plain radiograph and MR images of acute phase OVFs and the incidence of nonunion. As these risk factors are defined more clearly and further validated, they may become essential assessment tools for determining subsequent OVF treatments. Patients with one or more of the earlier-described risk factors for nonunion should be observed carefully and provided with more intensive treatments.

Prediction of Treatment Resistance in Conservative Treatment of Osteoporotic Vertebral Fractures Using Lateral Plain Dynamic Loading Radiographs

“…In previous reports, the occurrence of an intravertebral cleft at 6 months after treatment initiation was considered as non-union (pseudarthrosis) [6,12], and in most instances, such cases have been viewed as resistant to conservative treatment. However, in actual clinical settings, pain that persists for approximately 3 months after treatment initiation leads to deterioration of the patient's activities of daily living (ADL) and leaves the patient almost completely bedridden.…”

“…According to previous reports, the majority of clinical fractures with pain develop at the thoracolumbar junction (T11-L2) [5,6]. While bone union can be achieved with conservative treatment in the majority of cases, delayed union and pseudarthrosis occur in approximately 10% to 35% of patients [6][7][8]. In addition, patients who require surgery because of delayed union and pseudarthrosis often have fractures of the thoracolumbar junction [6,[9][10][11].…”

“…Conventionally, OVFs should be managed using conservative treatment and, because various types of evidence-based conservative treatment have been developed and tested, no standard treatment or treatment guidelines have been established. According to previous reports, the majority of clinical fractures with pain develop at the thoracolumbar junction (T11-L2) [5,6]. While bone union can be achieved with conservative treatment in the majority of cases, delayed union and pseudarthrosis occur in approximately 10% to 35% of patients [6][7][8].…”

“…While bone union can be achieved with conservative treatment in the majority of cases, delayed union and pseudarthrosis occur in approximately 10% to 35% of patients [6][7][8]. In addition, patients who require surgery because of delayed union and pseudarthrosis often have fractures of the thoracolumbar junction [6,[9][10][11]. If complete bone union is not achieved and the patient develops delayed union and pseudarthrosis, most will become bedridden due to persistent with severe pain.…”

“…The following have been suggested as factors contributing to resistance to conservative treatment: computed tomography (CT)images [6]. Although these findings are important, they are qualitative in nature and do not allow for the evaluation of the severity or size of the posterior wall injuries found on CT images or signal intensity changes on MRI images.…”