Radiographic Detection of Osteoporotic Vertebral Fracture without Collapse

Abstract

BackgroundOn retrospective basis, we investigated the detection of osteoporotic vertebral fractures (OVFs) without radiologic collapse using a modified Yoshida's classification, which was designed by the authors.MethodsWe observed 82 cases in 76 patients with confirmed OVFs without collapse at the thoracolumbar junction. The following factors were measured: age, gender, body mass index (BMI, kg/m2), bone mineral density (BMD, mg/cm3), type of a modified Yoshida's classification. The correct diagnosis rate for the presence and location of OVFs and the correct diagnosis rate according to the morphological type by a modified Yoshida's classification of the OVFs were analyzed.ResultsThe mean BMI was 21.2; mean BMD, 44.1; and T-score, -4.4. As for the four subtypes of anterior cortical morphological change, there were 14 cases of the protruding type, 12 cases of the indented type, 5 cases of the disrupted type and 8 cases of the prow type. As for the three subtypes of endplate depression, there were 20 cases of upper endplate depression, 12 cases of lower endplate depression and 11 cases of endplate slippage type. According to the examiners, there was a significant difference between being informed before and after the modified Yoshida's classification. For the relationship of examiners and the type of fracture, there was a significant difference between being informed before and after the modified Yoshida's classification, particularly in the protruding type and the upper plate type.ConclusionsA modified Yoshida's classification can be helpful for the diagnosis of OVFs without radiologic collapse in a simple radiograph.

Delayed Recognition of Thoracic and Lumbar Vertebral Compression Fractures in Minor Accident Cases

“…Initially, minor VCFs in patients with osteoporosis may not be visualized and only recognized on follow-up films [1-2]. Most importantly, areas that are not clinically suspected to contain pathology often do and could alter the diagnosis, treatment, and prognosis [3]. Additionally, poor image quality, regardless of type (i.e.…”

“…plain radiographs, CT, and MRI scans) may lead to false-negatives. This review found the majority of these VCFs to be located at the thoracolumbar junction/lower thoracic spine, an area which can be frequently overlooked or inadequately seen in routine lumbar imaging [3]. There should be a higher index of suspicion if the patient is complaining of persistent pain in a different spinal area after conservative treatment and especially around the thoracolumbar junction [4].…”

“…With clinical suspicion, an MRI or bone scan should be employed to demonstrate either edematous changes within the vertebral body and/or a fracture line, thereby showing an occult osteoporotic VCF [2- 3]. It is important to differentiate this process from malignant and other benign processes, as the vertebral body visualized on MRI may indicate a disease other than osteoporosis to the radiologist [2, 4, 6-7].…”

“…If the patient is not having significant improvement in symptoms, regardless of initial radiologic reports immediately after the injury, follow-up films may reveal a previously undetected fracture [2-3]. Serial imaging needs to be obtained in order to properly visualize a new VCF, a previously undiagnosed VCF, or track a possibly progressive deformity.…”

“…Although accidents are a known cause of VCFs they are frequently undiagnosed [2-3]. We have identified a subgroup of patients who were seen after minor falls or automobile accidents complaining of multiregional spine pain.…”