Delayed Post-traumatic Vertebral Collapse: MR Categorization and MR-Pathology Correlation

Abstract

Study DesignA retrospective study.PurposeTo categorize the MR appearance of ischemic vertebral collapse and to correlate surgical and histologic findings.Overview of LiteratureX-ray and MRI findings of delayed posttraumatic vertebral collapse shows several patterns. Histopathologic signs of osteonecrosis were present only in minor portion of cases sampled for biopsy of delayed post-traumatic vertebral collapse in the literature.MethodsTwenty-one patients (22 vertebral bodies), with surgically and histopathologically proven ischemic vertebral collapse were included. The patients were examined with a 1.5 T MR imager. Spin echo T1- and T2-weighted images were obtained in axial and sagittal planes. Two experienced musculoskeletal radiologists, who reached consensus, evaluated the MR images. Then, MR-pathology correlations were made.ResultsFour different MR patterns were identified. Fluid patterns, were seen in 14% (3/22) of the affected vertebral bodies, and were characterized by hypo-intense signals on T1-weighted images, and hyper-intense signals, similar to water, on T2-weighted images. Extensive bone necrosis was predominant. Compression pattern, the most common pattern, found in 41% (9/22 vertebral bodies), was characterized by a marked decrease of anterior column height. Bone necrosis, granulation tissue, marrow fibrosis, and reactive new bone formation were found in relatively equal proportion. Granulation pattern, seen in 27% (6/22 vertebral bodies), was characterized by hypo-intense signals on T1-weighted images, and intermediate signals on T2-weighted images. Extensive granulation tissue was predominant. Mixed patterns were present in 18% (4/22), of the vertebral bodies.ConclusionsAwareness of histopathologic correlation of MR patterns in patients with delayed post-traumatic vertebral collapse may facilitate effective interpretation of clinical MR images of the spine.

Comparison of percutaneous vertebroplasty and percutaneous kyphoplasty for the management of Kümmell’s disease

“…Recently, multiple synonymous terms have been used to describe Kümmell's disease, including intravertebral vacuum cleft, 2 3 6 12 13 14 intravertebral cleft, 15 16 17 18 intravertebral pseudoarthrosis, 7 19 vertebral osteonecrosis, 8 vertebral fluid collection associated with vertebral collapse 20 and delayed posttraumatic vertebral collapse. 21 22 Maldague et al . 1 first reported the IVP sign on X-ray, which was described as pathognomonic for Kümmell's disease.…”