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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References
Aligizakis A, Katonis P, Stergiopoulos K, Galanakis I, Karabekios S, Hadjipavlou A (2002) Functional outcome of burst fractures of the thoracolumbar spine managed non-operatively, with early ambulation, evaluated using the load sharing classification. Acta Orthop Belg 68:279–287
Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 8:817–831
Hawker G, Ridout R, Ricupero M, Jaglal S, Bogoch E (2003) The impact of a simple fracture clinic intervention in improving the diagnosis and treatment of osteoporosis in fragility fracture patients. Osteoporos Int 14:171–178
Keynan O, Fisher CG, Vaccaro A, Fehlings MG, Oner FC, Dietz J, Kwon B, Rampersaud R, Bono C, France J, Dvorak M (2006) Radiographic measurement parameters in thoracolumbar fractures: a systematic review and consensus statement of the spine trauma study group. Spine (Philadelphia, Pa. 1976) 31:E156–165
Kim DH, Vaccaro AR (2006) Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J 6:479–487
Machino M, Yukawa Y, Ito K, Kanbara S, Morita D, Kato F (2013) Posterior ligamentous complex injuries are related to fracture severity and neurological damage in patients with acute thoracic and lumbar burst fractures. Yonsei Med J 54:1020–1025
Magerl F, Aebi M, Gertzbein S, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201
McAfee PC, Yuan HA, Fredrickson BE, Lubicky J (1983) The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg 65:461–473
McCormack T, Karaikovic E, Gaines RW (1994) The load sharing classification of spine fractures. Spine 19:1741–1744
McKiernan F, Faciszewski T (2003) Intravertebral clefts in osteoporotic vertebral compression fractures. Arthritis Rheum 48:1414–1419
Mumford J, Weinstein JN, Spratt KF, Goel VK (1993) Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine (Philadelphia, Pa. 1976) 18:955–970
Oner FC, van der Rijt RR, Ramos LM, Dhert WJ, Verbout AJ (1998) Changes in the disc space after fractures of the thoracolumbar spine. J Bone Joint Surgery British 80:833–839
Patil S, Nene AM (2014) Predictors of kyphotic deformity in osteoporotic vertebral compression fractures: a radiological study. Eur Spine J 23:2737–2742
Reinhold M, Knop C, Beisse R, Audigé L, Kandziora F, Pizanis A, Pranzl R, Gercek E, Schultheiss M, Weckbach A, Bühren V, Blauth M (2010) Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, Internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Eur Spine J 19:1657–1676
Seo M, Park S, Park J, ** W, Ryu K (2011) Spinous process fractures in osteoporotic thoracolumbar vertebral fractures. Br J Radiol 84:1046–1049
Seo MR, Park SY, Park JS, ** W, Ryu KN (2011) Spinous process fractures in osteoporotic thoracolumbar vertebral fractures. Br J Radiol 84:1046–1049
Sugita M, Watanabe N, Mikami Y, Hase H, Kubo T (2005) Classification of vertebral compression fractures in the osteoporotic spine. J Spinal Disord Tech 18:376–381
Sugita M, Watanabe N, Mikami Y, Hase H, Kubo T (2005) Classification of vertebral compression fractures in the osteoporotic spine. J Spinal Disord Tech 18:376–381
Vaccaro AR, Lehman RA, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, Harrop J, Dvorak M, Wood K, Fehlings MG, Fisher C, Zeiller SC, Anderson DG, Bono CM, Stock GH, Brown AK, Kuklo T, Oner FC (2005) A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Philadelphia, Pa. 1976) 30:2325–2333
Vaccaro AR, Rihn JA, Saravanja D, Anderson DG, Hilibrand AS, Albert TJ, Fehlings MG, Morrison W, Flanders AE, France JC, Arnold P, Anderson PA, Friel B, Malfair D, Street J, Kwon B, Paquette S, Boyd M, Dvorak MF, Fisher C (2009) Injury of the posterior ligamentous complex of the thoracolumbar spine: a prospective evaluation of the diagnostic accuracy of magnetic resonance imaging. Spine (Philadelphia, Pa. 1976) 34:E841–847
Willén J, Anderson J, Toomoka K, Singer K (1990) The natural history of burst fractures at the thoracolumbar junction. J Spinal Disord 3:39–46
Wood KB, Li W, Lebl DS, Ploumis A (2014) Management of thoracolumbar spine fractures. Spine J 14:145–164
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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