What Effects Does Necrotic Area of Contrast-Enhanced MRI in Osteoporotic Vertebral Fracture Have on Further Compression and Clinical Outcome?

Abstract

ObjectiveThe objective of this study was to analyze the correlation between further compression and necrotic area in osteoporotic vertebral fracture (OVF) patients with contrast-enhanced magnetic resonance imaging (CEMRI). In addition, we investigated the radiological and clinical outcome according to the range of the necrotic area.MethodsBetween 2012 and 2014, the study subjects were 82 OVF patients who did not undergo vertebroplasty or surgical treatment. The fracture areas examined on CEMRI at admission were defined as edematous if enhancement was seen and as necrotic if no enhancement was seen. The correlation between further compression and the necrotic and edematous areas of CEMRI, age, and bone mineral density was examined. Also, necrotic areas were classified into those with less than 25% (non-necrosis group) and those with more than 25% (necrosis group) according to the percentages of the entire vertebral body. For both groups, further compression and the changes in wedge and kyphotic angles were examined at admission and at 1 week, 3 months, and 6 months after admission, while the clinical outcomes were compared using the visual analog scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status grade.ResultsFurther compression was 14.78±11.11% at 1 month and 21.75±14.43% at 6 months. There was a very strong correlation between the necrotic lesion of CEMRI and further compression (r=0.690, p<0.001). The compression of the necrosis group was 33.52±12.96%, which was higher than that of the non-necrosis group, 14.96±10.34% (p<0.005). Also, there was a statistically significantly higher number of intervertebral cleft development and surgical treatments being performed in the necrosis group than in the non-necrosis group (p<0.005). Moreover, there was a statistical difference in the decrease in the height of the vertebral body, and an increase was observed in the kyphotic change of wedge angle progression. There was also a difference in the VAS and ECOG performance scales.ConclusionThe necrotic area of CEMRI in OVF had a strong correlation with further compression over time. In addition, with increasing necrosis, intervertebral clefts occurred more frequently, which induced kyphotic changes and resulted in poor clinical outcomes. Therefore, identifying necrotic areas by performing CEMRI on OVF patients would be helpful in determining their prognosis and treatment course.

Natural changes of traumatic vertebral compression fractures during the first 6 months in patients visiting for disability certificates

“…[ 1 , 25 ] The local kyphotic angle of osteoporotic VCFs with necrotic area less than 25% of the entire vertebral body changed from 11.7 ± 6.5° initially to 15.9 ± 6.7° at six months. [ 5 ] Local kyphotic angle of traumatic VCFs in the current study showed less value than osteoporotic VCFs, but the change was more than 17.2% of baseline local kyphotic angle as MCID. [ 36 ]…”

“…This change corresponds to 18.1 ± 10.4% of the initial height and was smaller than that of osteoporotic VCFs, which decreases by 21.8 ± 14.4% at 6 months. [ 5 ] Traumatic VCFs were reported to show 19.8 ± 7.4% height loss after 2 years, [ 8 ] and therefore about 90% of this height loss was assumed to be obtained during the first six months.…”

“…Further height loss was observed in osteoporotic vertebral compression fractures (VCFs) because of the impaired healing process of the osteoporotic bone. [ 5 ] In osteoporosis, decreased bone mass and the degeneration of bone structures change pathological and inflammatory responses to fractures, and a gradual decrease in vertebral height was found in serial evaluations of osteoporotic VCFs. [ 5 – 7 ] Traumatic VCFs also showed the progression of vertebral collapse in studies involving long-time follow-up.…”

“…[ 5 ] In osteoporosis, decreased bone mass and the degeneration of bone structures change pathological and inflammatory responses to fractures, and a gradual decrease in vertebral height was found in serial evaluations of osteoporotic VCFs. [ 5 – 7 ] Traumatic VCFs also showed the progression of vertebral collapse in studies involving long-time follow-up. [ 4 , 8 ] Six months after the onset is the minimum duration required before a disability certificate can be issued in several countries; [ 9 – 11 ] it is also the criterion for distinguishing short-term and long-term disability.…”

Diagnostic Value of Magnetic Resonance (MR) Combined with Computed Tomography (CT) in Patients with Stress Injury of Femoral Neck

“…In this study, CT diagnosis shows clearly the fracture line, periosteum reaction, osteoporosis, callus formation, and other conditions, whereas MR diagnosis can grade the stress injury of patients. In the studies of Lee et al [ 18 ], it was believed that the MR grading of stress injury of the femoral neck was directly related to clinical response and also the scale standard for the degree of stress injury, which had a positive effect on improving the prognosis. It was proposed in the study of Schoenfeld et al [ 12 ] that wthn the combined diagnosis of CT and MR, changes in bone marrow signals could be identified to minimize the occurrence of high-level stress injury after treatment, namely, the occurrence of stress fracture.…”