Clin Orthop Surg.  2017 Jun;9(2):193-199. 10.4055/cios.2017.9.2.193.

Comparison of the Extent of Degeneration among the Normal Disc, Immobilized Disc, and Immobilized Disc with an Endplate Fracture

• Choi W
• Song S
• Chae S
• Ko S

• KMID: 2412288
• DOI: http://doi.org/10.4055/cios.2017.9.2.193

Abstract

BACKGROUND
This study attempts to prove a cause and effect relationship between spine immobilization following posterior fixation for unstable burst fractures and degeneration observed following hardware removal.
METHODS
We enrolled 57 patients (259 intervertebral discs [IVDs]) who underwent only posterior instrumentation without fusion for thoracolumbar and lumbar unstable burst fractures. We arbitrarily named the IVD that has an endplate fracture after immobilization using pedicle screws as the fractured endplate and immobilized disc (FEID), the IVD that has no endplate fracture after immobilization using pedicle screws as the nonfractured endplate and immobilized disc (NFEID), and the IVD that has no endplate fracture and no immobilization instrumentation as the normal disc (ND). At 2 years after implant removal, magnetic resonance imaging (MRI) was performed again for comparison. The extent of disc degeneration was classified using the Pfirrmann classification system.
RESULTS
FEIDs were present in 67 levels, NFEIDs in 78 levels, and NDs in 114 levels. According to the Pfirrmann classification, 7.9% of the NDs, 32.1% of the NFEIDs, and 43.3% of the FEIDs were more degenerated at 2 years after implant removal. The FEIDs and NFEIDs were more degenerated than the NDs and the FEIDs were more degenerated than the NFEIDs at statistically significant levels (p < 0.001 for both).
CONCLUSIONS
Spine immobilization with transpedicular screws has a significant influence on disc degeneration, and an endplate fracture accelerates the degeneration process.

Keyword

Intervertebral disc degeneration; Vertebral body; Immobilization

MeSH Terms

Adolescent
Adult
Cohort Studies
Female
Fracture Fixation, Internal/*statistics & numerical data
Humans
*Intervertebral Disc/diagnostic imaging/pathology/surgery
*Intervertebral Disc Degeneration/diagnostic imaging/pathology
Magnetic Resonance Imaging
Male
Middle Aged
Pedicle Screws
*Spinal Fractures/diagnostic imaging/pathology/surgery
Young Adult

Figure

• 

  Fig. 1 Displaced endplate fracture was diagnosed based on sagittal (A) and coronal (B) images of computed tomography.

• 

  Fig. 2 Intervertebral discs (IVDs) after instrumentation for spine fracture. ND: normal disc, an IVD that has no endplate fracture and no immobilization. NFEID: nonfractured endplate and immobilized disc, an IVD that has no endplate fracture but is immobilized using pedicle screws. FEID: fractured endplate and immobilized disc, an IVD that has endplate fracture and is immobilized using pedicle screws. *Fractured vertebra.

• 

  Fig. 3 Serial magnetic resonance imaging (MRI) showing more degenerative changes. (A) MRI imaging of the fractured vertebral body and injured endplate (white square) at the time of injury shows grade 1 degeneration. (B) Disc is homogeneous with bright hyperintense white signal intensity and normal disc height (white arrow). (C) MRI imaging of the treated vertebral body and endplate (yellow square) at 2 years after removal surgery shows grade 3 degeneration. (D) Disc is inhomogenous with an intermittent gray signal intensity and disc height is slightly or moderately decreased (yellow arrow).

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