Injury to the vertebral endplate-disk complex associated with osteoporotic vertebral compression fractures.
OBJECTIVE
MR imaging has been used extensively for identification and determination of chronicity of VCF. A major emphasis is placed on identification of edema or fluid clefts within the vertebral body. Little attention is given to other spinal structures such as vertebral endplate, intervertebral disk, posterior elements, and facet joints, spinal ligaments, and paraspinal musculature. Our objective was to assess the incidence of vertebral endplate and adjacent-level intervertebral disk injury as seen on MR imaging studies of patients with acute or subacute painful osteoporotic vertebral compression fractures.


METHODS
We performed a retrospective review of spine MR imaging examinations in all patients who presented to our institution for subsequent treatment with vertebral augmentation. One hundred six patients had MR imaging studies and reports available for review. A total of 211 acute or subacute vertebral compression fractures were identified in this group of patients. All fracture levels were evaluated for the presence or absence of vertebral endplate and/or associated intervertebral disk injury.


RESULTS
Detailed analysis of the images showed a high incidence of endplate and intervertebral disk injury. Superior vertebral endplate injury (39%) was more common than inferior endplate injury (12%), while the combination of both was observed in 29% of the levels. The pattern of intervertebral disk injury was similar, with injury to the disk above the fracture (36%) more common than injury to the disk below the fracture level (15%). While the official radiology reports correctly identified the vertebral compression fractures, they did not mention or describe the associated vertebral endplate or disk abnormalities.


CONCLUSIONS
Vertebral endplate injury is commonly seen in osteoporotic vertebral compression fractures. Furthermore, this is frequently associated with injury to the adjacent intervertebral disk. These findings are often under-reported but should be described because they may have important implications for symptomatic presentation, patient management, and outcomes.
Ortiz
A O
AO
Department of Radiology, Winthrop University Hospital, Mineola, New York 11501, USA.
Bordia
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050815:Fractures, Compression / Q000473:pathology*; D006801:Humans; D007403:Intervertebral Disc / Q000293:injuries* / Q000473:pathology*; D007405:Intervertebral Disc Displacement / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000473:pathology*
Top Magn Reson Imaging. 2000 Aug;11(4):235-44
11133065
J Vasc Interv Radiol. 2007 Mar;18(3):325-30
17377175
J Comput Assist Tomogr. 2006 May-Jun;30(3):501-6
16778629
AJNR Am J Neuroradiol. 2004 Feb;25(2):175-80
14970015
JAMA. 2001 Jan 17;285(3):320-3
11176842
AJNR Am J Neuroradiol. 2008 Aug;29(7):1285-7
18417606
Spine (Phila Pa 1976). 2003 May 15;28(10):991-6
12768136
Spine (Phila Pa 1976). 2007 Jul 1;32(15):E419-22
17621198
Eur Spine J. 2007 Dec;16(12):2118-25
17713795
Radiology. 2009 Jun;251(3):866-72
19336665
Eur Spine J. 2003 Aug;12(4):421-6
12687437
Acta Anat (Basel). 1959;38:96-113
14420325
Radiology. 2003 Jan;226(1):119-24
12511679