Osteoporotic vertebral fractures: predictive factors for conservative treatment failure. A systematic review
Open Access
- 30 September 2018
- journal article
- review article
- Published by Springer Science and Business Media LLC in European Spine Journal
- Vol. 27 (10), 2565-2576
- https://doi.org/10.1007/s00586-017-5340-z
Abstract
Purpose To analyze clinical, radiographic and magnetic resonance findings that might predict risk of complications and conservative treatment failure of osteoporotic vertebral fractures. Methods The authors conducted a systematic review of observational studies, collecting data on osteoporotic vertebral fracture and complications like vertebral collapse, kyphosis, pseudoarthrosis, and neurologic deficit. MeSH items such as 'spinal fracture/radiology,' 'spinal fracture/complications,' 'spinal fracture/diagnosis' were used. PRISMA statement criteria were applied, and the risk of bias was classified as low, medium, high, following the Newcastle-Ottawa Quality Assessment Scale (NOS). Results Eleven cohort studies, either retrospective or prospective, met the eligibility criteria and were included in the review. Major risk factors that were statistically predictive of the following complications were as follows; (1) vertebral collapse: presence of intravertebral cleft, MR T1-WI 'total type fractures' and T2-WI 'hypointense-wide-type'. (2) Pseudoarthrosis (nonunion): middle-column damage, thoracolumbar vertebrae involvement, MR T2-WI confined high-intensity pattern and diffuse low intensity pattern. (3) Kyphotic deformity: thoracolumbar fracture and superior endplate fracture. (4) Neurologic impairment: a retropulsed bony fragment occupying more than 42% of the sagittal diameter of the spinal canal and a change of more than 15 degrees in vertebral wedge angle on lateral dynamic radiography. Conclusions Shape and level of the fracture were risk factors associated with the progression of collapse, pseudoarthrosis, kyphotic deformity and neurologic impairment. MRI findings were often related to the failure of conservative treatment. If prognosis can be predicted at the early fracture stage, more aggressive treatment options, rather than conservative ones, might be considered.Keywords
This publication has 46 references indexed in Scilit:
- Characteristic Radiographic or Magnetic Resonance Images of Fresh Osteoporotic Vertebral Fractures Predicting Potential Risk for NonunionSpine, 2011
- Value of MRI imaging prior to a kyphoplasty for osteoporotic insufficiency fracturesEuropean Spine Journal, 2009
- Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fractureEuropean Spine Journal, 2009
- Risk Factors for the Progressive Osteoporotic Spinal FractureJournal of Korean Society of Spine Surgery, 2009
- Dynamic Contrast-Enhanced Magnetic Resonance Imaging of Osteoporotic Vertebral FractureSpine, 2003
- Magnetic resonance imaging diagnosis and new classification of the osteoporotic vertebral fractureJournal of Orthopaedic Science, 2003
- MRI findings on healing process of vertebral fracture in osteoporosisJournal of Orthopaedic Science, 1996
- Osteoporotic vertebral collapse with late neurological complicationsSpinal Cord, 1995
- Incidence of clinically diagnosed vertebral fractures: A population-based study in rochester, minnesota, 1985-1989Journal of Bone and Mineral Research, 1992