Clin Orthop Surg.  2013 Sep;5(3):195-201. 10.4055/cios.2013.5.3.195.

Usefulness of Prone Cross-Table Lateral Radiographs in Vertebral Compression Fractures

• Cho JH
• Shin SI
• Lee JH
• Yeom JS
• Chang BS
• Lee CK

• KMID: 1705545
• DOI: http://doi.org/10.4055/cios.2013.5.3.195

Abstract

BACKGROUND
Dynamic radiographs are recommended to investigate non-healing evidence such as the dynamic mobility or intravertebral clefts in osteoporotic vertebral compression fractures (VCFs). However, it is difficult to examine standing flexion and extension lateral radiographs due to severe pain. The use of prone cross-table lateral radiographs (PrLRs) as a diagnostic tool has never been proposed to our knowledge. The purpose of this study is to clarify the usefulness of PrLRs in diagnosis and treatment of VCFs.
METHODS
We reviewed 62 VCF patients examined with PrLRs between January 1, 2008 and June 30, 2011. To compare the degree of pain provoked between standing extension lateral radiographs (StLRs) and PrLRs, numeric rating scale (NRS) scores were assessed and compared by a paired t-test. Vertebroplasty was done for 40 patients and kyphoplasty was done for 9 patients with routine manners. To assess the degree of postural reduction, vertebral wedge angles (VWA) and vertebral height ratios (VHR) were calculated by using preoperative StLRs, PrLRs, and postoperative lateral radiographs. Two variables derived from changes in VWA and VHR between preoperative and postoperative radiographs were compared by a paired t-test.
RESULTS
The average NRS scores were 6.23 +/- 1.67 in StLRs and 5.18 +/- 1.47 in PrLRs. The degree of pain provocation was lower in using PrLRs than StLRs (p < 0.001). The average changes of VWA between preoperative and postoperative status were 5.24degrees +/- 6.16degrees with PrLRs and 3.46degrees +/- 3.47degrees with StLRs. The average changes of VHR were 0.248 +/- 0.178 with PrLRs and 0.148 +/- 0.161 with StLRs. The comparisons by two variables showed significant differences for both parameters (p = 0.021 and p < 0.001, respectively). The postoperative radiological status was reflected more precisely when using PrLRs than StLRs.
CONCLUSIONS
In comparison with StLR, the PrLR was more accurate in predicting the degree of restoration of postoperative vertebral heights and wedge angles, and provoked less pain during examination. The PrLR could be a useful diagnostic tool to detect intravertebral cleft or intravertebral dynamic instability.

Keyword

Prone lateral radiograph; Vertebroplasty; Kyphoplasty; Osteoporosis; Vertebral fracture; Intravertebral cleft

MeSH Terms

Aged
Aged, 80 and over
Female
Fractures, Compression/*radiography/surgery
Humans
Male
Osteoporosis/pathology/radiography
Posture/physiology
Radiography/*methods
Retrospective Studies
Spinal Fractures/*radiography/surgery
Spine/pathology/*radiography/surgery
Vertebroplasty

Figure

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  Fig. 1 The illustration of the diagnostic position for prone cross-table lateral radiographs (PrLR). The direction of arrow means trajectory of x-ray beam.

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  Fig. 2 The parameters and calculating method from lateral radiographs. VWA (vertebral wedge angle) = Cobb's angle between Line 1 and Line 2, VHR (vertebral height ratio) = a / (b + c) × 2.

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  Fig. 3 The illustration of intravertebral instability for T12 compression fracture in a 76-year-old man who suffered from back pain for 6 months. (A) A standing extension lateral radiograph showed severe compression fracture at T12 vertebra. (B) A prone cross-table lateral radiograph revealed a vacuum cleft (arrow) in the body and slight reduction of vertebral height. (C) Vertebroplasty was done and the pain was alleviated.

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