Efficacy of the dynamic radiographs for diagnosing acute osteoporotic vertebral fractures

Niimi, Rui; Kono, Takako; Nishihara, Atsushi; Hasegawa, Masahiro; Matsumine, Akihiko; Sudo, Akihiro

doi:10.1007/s00198-013-2456-9

Cited by 15 publications

(21 citation statements)

References 23 publications

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“…The present conservative treatment protocol was as follows: all patients with the suspicion or the diagnosis of OVF were admitted. The fractures were confirmed by MRI, computed tomography (CT) scan, and dynamic X-ray in standing and supine position [ 19 ]. From these imaging examinations, patients with definitive diagnosis of OVF were forbidden to sit up even for dietary intake and evacuation during the initial 2 weeks [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Initial hospitalization with rigorous bed rest followed by bracing and rehabilitation as an option of conservative treatment for osteoporotic vertebral fractures in elderly patients: a pilot one arm safety and feasibility study

et al. 2018

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SummaryWe assessed the safety and feasibility of a unified conservative treatment protocol for osteoporotic vertebral fractures in the elderly patients with a 24-week follow-up. Our results showed that initial hospitalization with rigorous bed rest followed by a rehabilitation program using a Jewett brace was safe and feasible in managing patients.PurposeThe purpose of this study was to prove the safety and feasibility of a unified conservative treatment protocol, which included initial hospitalization with rigorous bed rest followed by a rehabilitation program with Jewett brace for osteoporotic vertebral fractures (OVFs) in the elderly patients with a 24-week follow-up.MethodsBetween April 2012 and Mach 2015, one hundred fifty-four patients met the eligibility for this study. Radiological findings at the 3-week, 6~8-week, 24-week assessment were evaluated. Among these, 11 patients underwent early surgery within the first 2 weeks after admission and 19 patients lost follow-up. Therefore, 124 patients were assessed at the final follow-up visit.ResultsThe average vertebral instability in all the present series was 4.9 ± 4.8° at 3-week, 2.9 ± 3.5° at 6~8-week, and 1.8 ± 3.0° at 24-week follow-up visit. Delayed union was observed in 16 patients on the 24-week follow-up visit. Therefore, the present conservative treatment protocol resulted in bony union in 98 out of 124 patients (79.0%, per protocol set analysis) and 98 out of 154 patients including drop-out (63.6%, intention-to-treat analysis). There was no severe adverse event related to initial bed rest. The vertebral instability at 3-week assessment was significantly higher in the delayed union group when compared with that in the union group. Univariate analyses followed by multivariate logistic regression analysis revealed that T2-weighted image of confined high intensity on MRI and having more than 5° of vertebral instability on dynamic X-ray at 3-week assessment are the independent risk factors for delayed union of conservative treatment in the present series.ConclusionsOur results showed that initial hospitalization with rigorous bed rest followed by a rehabilitation program using a Jewett brace was safe and feasible. Therefore, the present conservative treatment protocol can be one of the acceptable treatment options in managing OVF patients.

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Section: Methodsmentioning

confidence: 99%

Initial hospitalization with rigorous bed rest followed by bracing and rehabilitation as an option of conservative treatment for osteoporotic vertebral fractures in elderly patients: a pilot one arm safety and feasibility study

et al. 2018

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“…Plain dynamic loading radiography improves the diagnostic accuracy of OVFs at the time of the initial visit [5]. In addition, this study demonstrated that plain dynamic loading radiography is an extremely useful imaging tool for the quantitative evaluation of vertebral body instability.…”

Section: Discussionmentioning

confidence: 66%

“…Second, the cases included were limited to fractures affecting the thoracolumbar junction, and patients with secondary osteoporosis were excluded; therefore, the findings of the present study cannot be generalized to all kinds of OVFs. However, in clinical settings, particularly in postmenopausal women, secondary osteoporosis accounts for approximately 20% or <30% of all cases of osteoporosis [24,25], and fractures of the thoracolumbar junction account for the majority of OVFs [5,6]. Although a larger study is needed to confirm and generalize the results of the present study for all OVF cases, a plain dynamic loading radiography is an extremely useful imaging tool, which allows for the resistance of OVFs to conservative treatment to be quantitatively evaluated based on vertebral body instability in most cases.…”

Section: Discussionmentioning

confidence: 99%

“…Conventionally, OVFs should be managed using conservative treatment and, because various types of evidence-based conservative treatment have been developed and tested, no standard treatment or treatment guidelines have been established. According to previous reports, the majority of clinical fractures with pain develop at the thoracolumbar junction (T11-L2) [5,6]. While bone union can be achieved with conservative treatment in the majority of cases, delayed union and pseudarthrosis occur in approximately 10% to 35% of patients [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…Plain dynamic loading radiography involves taking images of the lateral surface of the vertebral body in both postures and calculating changes in vertebral height between the two. This method is believed to significantly improve the accuracy of the diagnosis of fresh fractures at the time of the first visit [5] compared to conventional bidirectional plain radiography, which is performed in the supine position for anterior-posterior imaging and in the side-lying non-loaded position for lateral imaging [17]. In addition, by using images obtained from plain dynamic loading radiography to measure differences in vertebral collapse rate in the standing/sitting and supine position, instability of the fractured vertebral body in a loaded posture and non-loaded posture can be evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of Treatment Resistance in Conservative Treatment of Osteoporotic Vertebral Fractures Using Lateral Plain Dynamic Loading Radiographs

Funayama¹,

Tsukanishi²,

Abe³

et al. 2017

J Spine

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Purpose: To elucidate the association between computed tomography (CT)/magnetic resonance imaging (MRI) and radiographic findings of fractured vertebral body instability in patients with osteoporotic vertebral fractures and to clarify whether resistance to conservative treatment can be evaluated on the basis of dynamic loading radiography.Methods: Seventy-eight patients aged ≥ 65 years who underwent conservative treatment for osteoporotic single vertebral fractures of the thoracolumbar junction were divided into the conservative treatment-resistant group (18 patients) and control group (60 patients). We evaluated the accuracy of the prediction of resistance to conservative treatment on the basis of the CT/MRI findings and the difference in compression rates between standing and supine positions at the time of the first visit. The differences in compression rates (%) were compared between the two groups. In addition, a receiver operating characteristics (ROC) curve was drawn to evaluate the accuracy of the prediction of resistance to conservative treatment. Results:In patients without (47 cases) and with CT findings (31 cases), the mean differences in compression rates (%) was 8.9% and 19.1%, respectively (p=0.0029). The mean differences in compression rates (%) of patients without (60 cases) and with MRI findings (18 cases) was 9.7% and 24.0%, respectively (p=0.0043). The mean differences in compression rates (%) in the conservative treatment-resistant group was 26.3%, while that in the control group was 9.0 (p=0.0066). In addition, according to the ROC curve of the difference in compression rate was 0.93 (95% confidence interval: 0.87-1), and when a 20% difference in compression rate was considered as the threshold value.Conclusion: Dynamic loading radiography is useful for the evaluation of resistance to conservative treatment in patients with osteoporotic vertebral fractures, and that a compression rate difference of ≥ 20% predicts resistance to conservative treatment.

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A novel radiological assessment to identify acute vertebral compression fractures: A pilot observational study

Tsuruta,

Ueyama,

Watanabe

et al. 2023

Acute Medicine & Surgery

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AimThe diagnosis of acute vertebral compression fractures (AVCFs) is often challenging. An alternative to magnetic resonance imaging, which may not always be available, includes a comparison of supine and sitting/standing position radiographs. However, this cannot be accomplished in patients with acute vertebral compression fractures who require emergency transport and are in severe pain. In this study, aimed to assess the diagnostic accuracy of comparing lateral‐view radiographs of the thoracolumbar spine in supine and 30° head‐elevated positions, which are less painful.MethodsWe retrospectively examined 30 patients with AVCFs who were transported by ambulance to our emergency department between June 2018 and May 2019. All underwent 30° head‐elevated lateral‐view thoracolumbar spine radiography and magnetic resonance imaging. We evaluated vertebral fractures by examining changes in vertebral wedging ratio (WR) from supine to 30° head‐elevated position (Δ WR) using the following equation: Δ WR = WR (30° head‐elevated) – WR (supine). We compared Δ WR to that of unfractured vertebrae as control.ResultsA total of 176 vertebrae were included (fractured, 32 and non‐fractured, 144). Δ WR of fractured vertebrae ranged between 5.1% and 24.4%, whereas non‐fractured vertebrae ranged between −6.7% and 4.3%. Median Δ WR of fractured vertebrae was significantly higher than non‐fractured vertebrae (12.6% versus −0.5%, p < 0.001). No patients reported pain during 30° head‐elevated positioning.ConclusionsLateral radiographs in supine and 30° head‐elevated positions can accurately diagnose of AVCF, without worsening pain. This study showed a Δ WR value of ≥5.1% for AVCFs.

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Efficacy of the dynamic radiographs for diagnosing acute osteoporotic vertebral fractures

Abstract: Dynamic radiographs provide a convenient way to identify acute OVFs.

Cited by 15 publications

References 23 publications

Initial hospitalization with rigorous bed rest followed by bracing and rehabilitation as an option of conservative treatment for osteoporotic vertebral fractures in elderly patients: a pilot one arm safety and feasibility study

Initial hospitalization with rigorous bed rest followed by bracing and rehabilitation as an option of conservative treatment for osteoporotic vertebral fractures in elderly patients: a pilot one arm safety and feasibility study

Prediction of Treatment Resistance in Conservative Treatment of Osteoporotic Vertebral Fractures Using Lateral Plain Dynamic Loading Radiographs

A novel radiological assessment to identify acute vertebral compression fractures: A pilot observational study

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