Reduction of vertebral height with fragility vertebral fractures can induce variety of neurological deterioration

Abstract

BackgroundThe presence of vertebral fractures affect variations in the termination level of conus medullaris (TLCM) and alter neurological findings. However, few studies have examined association between vertebral fractures, TLCM, and neurological findings. Thus, we herein studied the number and severity of vertebral fractures, TLCM, and neurological findings to clarify the mechanism of neurological deterioration in patients with vertebral fractures.MethodsA total of 411 patients who underwent computed tomographic myelography were classified into those with (group F, n = 73) and those without vertebral fractures (group C, n = 338). We assessed correlations between TLCM and age, height, and gender in group C, differences in TLCM between groups F and C, and correlations between TLCM, and the number and severity score of fractures. Neurological evaluations were performed for the patellar tendon reflex (PTR), muscle weakness, sensory disturbance, and bladder contraction disorders.ResultsTLCM was most commonly located at the L1 vertebral body in group C and did not significantly differ with age, height, or gender. TLCM was most commonly located at L2 vertebral body in group F. TLCM was more caudally located in group F (P < 0.01). Additionally, there was a significant difference between TLCM and number of fractures, and the severity score of fractures (both P < 0.01). Twenty-three patients showed neurological deterioration by vertebral fractures. Some patients with T12 vertebral fracture showed hyperreflexia of PTR. Serious bladder contraction disorders were seen in patients with compression at close range of TLCM.ConclusionWe confirmed that vertebral fractures altered location of the TLCM, thus altering potential neurological symptoms. Moreover, there were correlations of the TLCM with the number and severity score of vertebral fractures. Spine surgeons should be cognizant of the relationship between TLCM, level of compressive lesion, and neurological findings to avoid the wrong level in spine surgery and unexpected neurological deteriorations after surgery.

Percutaneous vertebroplasty vs balloon kyphoplasty in the treatment of newly onset osteoporotic vertebral compression fractures

“…Third, during the VP procedure, bone cement can diffuse into the trabecular space of the osteoporotic bone, which increases its ability to withstand pressure. [ 18 , 19 ]…”

Risk Factors for Failure in Conservatively Treated Osteoporotic Vertebral Fractures: A Systematic Review

“…[12][13][14][15] Furthermore, the change of the anatomical relation between the vertebral column and the spinal cord due to fracturerelated deformity is an underestimated factor. 30 Especially, changes in the context of fractures can cause variations in the termination level of the medullary cone, which may pose a risk factor for delayed neurological deterioration. 30 With a focus on vertebral collapse and kyphosis, posterior vertebral body height loss, fracture involvement of both endplates, location at the thoracolumbar junction, AO Spine type A4 fracture as well as adjacent level fractures were negative prognostic factors.101 720 Furthermore, Sugita defined different types of fractures, whereby bow-shaped type fractures, projecting type fractures and swelled front type fractures were associated with higher rates of vertebral collapse.…”

“…Other potential risk factors that have been investigated include the timing of return to physical activity and medication with bisphosphonates. 28 - 30 Kataoka et al performed an observational investigation and found no association between early physical activity and progression of the fractured vertebral body’s collapse. 28 In a prospective study with 105 patients included, bisphosphonate use had no impact on pain and functional results during the conservative treatment of osteoporotic vertebral fractures.…”

“… 12 - 15 Furthermore, the change of the anatomical relation between the vertebral column and the spinal cord due to fracture-related deformity is an underestimated factor. 30 Especially, changes in the context of fractures can cause variations in the termination level of the medullary cone, which may pose a risk factor for delayed neurological deterioration. 30 …”

“… 30 Especially, changes in the context of fractures can cause variations in the termination level of the medullary cone, which may pose a risk factor for delayed neurological deterioration. 30 …”