Endplate and intervertebral disc injuries in acute and single level osteoporotic vertebral fractures: is there any association with the process of bone healing?

Abstract

Background The endplate-intervertebral disc (IVD) complex is closely interrelated with the vertebral body (VB) in the structural integrity of the anterior spinal column, including biomechanical and biological functions. Endplate and IVD injuries are usually found in association with vertebral fractures (VFs); however, little is known about their relevance to the healing of osteoporotic VFs (OVFs). The first purpose of this study was to evaluate the incidence and occurrence pattern of endplate and IVD injuries associated with single- and acute-OVFs, and the second was to evaluate the influence of endplate and IVD injuries on the occurrence of delayed union. Methods Endplate and IVD injuries associated with single- and acute-OVFs were retrospectively evaluated using magnetic resonance imaging (MRI). Vertebrae of 168 patients were included in the study. The occurrence rate and type of endplate and IVD injuries were radiologically evaluated, and the association between endplate and IVD injuries was statistically analyzed. Vertebrae of 85 patients, who received conservative treatment for acute OVFs, were included in the study and classified into two groups, union and delayed union, at 6 months after injury. To identify factors predicting delayed union, uni- and multivariate statistical analyses were performed. Vertebral MRI signal alternation patterns and endplate and IVD injuries were included as candidate factors in the logistic model. Results In association with OVFs, endplate injuries were observed in 103 of the 168 vertebrae (61%), and IVDs lesions were observed in 101 of 168 OVFs (60%); the occurrence of both injuries was significantly associated. Although no significant association with endplate and IVD injuries was identified, multivariate analysis demonstrated that intravertebral signal alternation (focal high signal intensity) and posterior wall injury were independent risk factors that predicted delayed union. Conclusions The results of this study showed that endplate and IVD injuries were found in approximately 60% of single and acute OVFs. These results suggest that fracture healing of OVFs would be mainly attributed to vertebral factors, including mechanical stress and metabolic status, among the three components of the anterior spinal column.

Investigation of Preoperative Traction Followed by Percutaneous Kyphoplasty Combined with Percutaneous Cement Discoplasty for the Treatment of Severe Thoracolumbar Osteoporotic Vertebral Compression Fractures

“…However, although PVP or PKP can relieve the pain caused by fracture, it cannot correct the secondary kyphosis, let alone complications caused by kyphosis, such as muscle fatigue, chronic pain, and so on. [23][24][25] Additionally, some studies suggest that, OVCFs, like vertebral fractures caused by trauma, are often complicated with intervertebral disc and cartilage endplate injuries. If these complicated injuries are ignored, postoperative pain symptoms cannot be completely relieved, and the kyphosis would be gradually aggravated due to the cartilage endplate and intervertebral disc injuries, which cannot be prevented by vertebroplasty.…”

Association between non-traumatic vertebral fractures and adjacent discs degeneration: a cross-sectional study and literature review

“…First, endplate and IVD injuries directly caused by VFs promote the progression of disc degeneration. Fujiwara and colleagues reported that endplate injuries were observed in 61%, and IVD lesions in 60% of patients with an acute, single osteoporotic VF [ 38 ]. Second, the progression of vertebral collapse is thought to cause impaired blood flow in vertebral bodies, to reduce blood flow and nutrient supply to the disc, and to cause disc degeneration [ 1 , 5 ].…”

Association Between Non-traumatic Vertebral Fractures and Adjacent Discs Degeneration: A Cross-sectional Study and Literature Review

“…First, endplate and IVD injuries directly caused by VFs promote the progression of disc degeneration. Fujiwara and colleagues reported that endplate injuries were observed in 61%, and IVD lesions in 60% of patients with an acute, single osteoporotic VF [28]. Second, the progression of vertebral collapse is thought to cause impaired blood ow in vertebral bodies, to reduce blood ow and nutrient supply to the disc, and to cause disc degeneration [1,5].…”