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Osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture without posterior ligament injury: its clinical and radiologic significances

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Abstract

Purpose

To assess the clinical and radiologic outcome of osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture (SPF) without posterior ligament injury.

Methods

A total of 391 patients with single-level osteoporotic thoracolumbar junctional (T10-L2) fracture were selectively enrolled. The patients were divided into two groups by absence (group I) or presence (group II) of SPF. Clinical and radiologic parameters were compared between the two groups.

Results

Group I comprised of 332 patients with only vertebral body fracture, and group II comprised of 59 patients with both vertebral body and SPFs. In all cases of group II, SPFs were located just one level above the fractured vertebral body, and the injury of the posterior ligament was not found. At the time of injury, group II patients showed worse outcomes in anterior vertebral body compression percentage, kyphotic Cobb angle, cranial disk status, and the rate of the initial neurologic injury. Kyphotic alignment changes during 1-year follow-up were compared between the conservative subgroups of groups I and II. At the time of injury, there were no statistical differences in anterior vertebral body compression percentage and Cobb angle between the two conservative subgroups. However, the difference was significant after 1-year follow-up. Comparison of kyphotic alignment change at 12 months after diagnosis within group II was done according to the treatment method. Vertebroplasty subgroup in group II did not show benefit even in preventing such kyphotic alignment change, whereas instrumentation subgroup in group II showed lordotic alignment restoration despite more severe kyphotic alignment at the time of injury.

Conclusions

Osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture without posterior ligament injury represented more severe injury with flexion forces on the anterior column and tensile forces on the posterior column, and was related with more severe posttraumatic kyphotic changes during the 12-month follow-up.

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Authors and Affiliations

  1. Spine Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896, Pyeongchon-Dong, Anyang City, Gyeonggi-Do, 431-070, Korea

    Seonjong Lee, Moon Soo Park, Yong-Chan Kim & Tae-Hwan Kim

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  1. Seonjong Lee
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  2. Moon Soo Park
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  4. Tae-Hwan Kim
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Correspondence to Tae-Hwan Kim.

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No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Lee, S., Park, M.S., Kim, YC. et al. Osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture without posterior ligament injury: its clinical and radiologic significances. Eur Spine J 25, 3478–3485 (2016). https://doi.org/10.1007/s00586-016-4634-x

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  • DOI: https://doi.org/10.1007/s00586-016-4634-x

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