J Korean Soc Spine Surg.  2009 Sep;16(3):153-159. 10.4184/jkss.2009.16.3.153.

Risk Factors for the Progressive Osteoporotic Spinal Fracture

• Sohn JM
• Kim KW
• Ha KY
• Ha NK
• Kim YH
• Kim JH

• KMID: 2003108
• DOI: http://doi.org/10.4184/jkss.2009.16.3.153

Abstract

STUDY DESIGN: Retrospective risk-factor analysis
OBJECTIVES
This study investigated the clinical and radiological risk factors associated with the progression of osteoporotic spinal fractures (OSFs) after conservative treatment. SUMMARY OF THE LITERATURE REVIEW: Nonunion and cleft signs on radiographs are strongly associated with complicated osteoporotic spinal fractures.
MATERIALS AND METHODS
From Jan. 2005 to Dec. 2007, 84 patients (15 males and 69 females; mean 72.6 yrs) were enrolled in this retrospective review. The progressive OSF, clinical and radiological factors were analyzed considering the progression of the kyphotic angle (PKA>20degrees) and the presence of intravertebral cleft signs (IVC). Age, gender, body mass index, vertebral level involved, BMD score, MRI classification and initial kyphotic angle were adopted for the analysis. For statistical analysis, a chi-square test was performed to analyze the relationship between each factor and multiple logistic regression analysis was performed to analyze the multifactorial explanatory factor.
RESULTS
The presence of IVC was related to the thoracolumbar fracture, mid-portion MR classification and high body mass index. PKA>20degrees was related to the thoracolumbar fracture and mid-portion classification. For multifactorial analysis using these seven factors, two factors (the level of fracture and MR classification) were found to be associated with the presence of IVC with statistical significance. In the thoracolumbar fracture, the incidence of IVC was 5.2 times higher than the other levels. The incidence of IVC in endplate classification was 16% lower than in the mid-portion.
CONCLUSION
BMI, the fracture level involved and MR classification were associated with the development of IVC and PKA>20degrees for a conservative treatment of OSF. Multiple logistic analysis revealed the level of the fracture and MR classification to be significant.

Keyword

Osteoporosis; Spinal fracture; Nonunion; Risk factors

MeSH Terms

Body Mass Index
Humans
Incidence
Logistic Models
Male
Osteoporosis
Retrospective Studies
Risk Factors
Spinal Fractures

Figure

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  Fig. 1. A case of complicated osteoporotic compression fracture. A 65-year-old woman suffered from intractable back and flank pain and progressive weakness of the lower extremities. She underwent anterior decompression and fusion surgery.

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  Fig. 2. MRI characteristics of osteoporotic compression fracture. (A) The cases with findings of signal change around the endplate and disruption of endplate are classified as an endplate type. (B) The cases with findings of signal change at the midportion of vertebral body and disruption of anterior cortex are classified as a midportion type.

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