title: Asymmetrical vertebral collapse from spinal metastasis in lower thoracic and lumbar spine.
abstract: OBJECTIVE
  The purpose of this study was to investigate the differences between spinal metastasis and osteoporotic compression fractures on plain X-ray images, focusing on asymmetrical vertebral collapse and fracture level.
  
  
  METHODS
  This study included 180 patients with pathological collapse from spinal metastasis (188 vertebrae) who were treated at our institution and 70 patients (92 vertebrae) with osteoporotic compression fractures. Anteroposterior X-ray images of the lower thoracic and lumbar spine were evaluated for asymmetrical collapse deformity.
  
  
  RESULTS
  Asymmetrical collapse was found in 134 vertebrae (71.3%) with metastasis, and in 20 osteoporotic vertebrae (21.7%); this difference was significant (p < 0.0001). The asymmetrical collapse angle in spinal metastasis patients ranged from 0 to 18°, with a mean of 7.0 and a standard deviation (SD) of 4.5. In contrast, the asymmetrical collapse angle in patients with osteoporotic fractures ranged from 0 to 13°, with a mean of 3.1 and a SD of 2.8. The difference in collapse angle between the two groups was statistically significant (p < 0.001). The cutoff value to suspect spinal metastasis was determined to be 5° or more (sensitivity 0.67, specificity 0.74). Fracture at Th10 or below L3 was found in 20.2% of spinal metastasis patients; only 3% of osteoporotic fractures occurred at these levels.
  
  
  CONCLUSIONS
  Asymmetrical collapse with an angle of 5° or more and fractures at atypical levels on plain radiographs can be useful clues to spinal metastasis.
authors.affiliation: Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka 411-8777, Japan. Electronic address: takayoshisuzuki3141116@msn.com.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka 411-8777, Japan. Electronic address: h.katagiri@scchr.jp.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Katagiri
authors.affiliation: Department of Public Heath, Health Management and Policy, Nara Medical University, 840 Shijyou-cho, Kashihara City, Nara 634-8521, Japan. Electronic address: noda@naramed-u.ac.jp.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Noda
authors.affiliation: Division of Orthopedic Surgery, National Hospital Organization Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Shizuoka 411-8611, Japan. Electronic address: shusukeohta@yahoo.co.jp.
authors.forename: Shusuke
authors.initials: S
authors.lastname: Ota
authors.affiliation: Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka 411-8777, Japan. Electronic address: h.murata@scchr.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Murata
authors.affiliation: Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka 411-8777, Japan. Electronic address: j.wasa@scchr.jp.
authors.forename: Junji
authors.initials: J
authors.lastname: Wasa
authors.affiliation: Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka 411-8777, Japan. Electronic address: s.hosaka@scchr.jp.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Hosaka
authors.affiliation: Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka 411-8777, Japan. Electronic address: shimo04@fujita-hu.ac.jp.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shimoyama
authors.affiliation: Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Shizuoka 411-8777, Japan. Electronic address: m.takahashi@scchr.jp.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D050815:Fractures, Compression / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005598:Fractures, Spontaneous / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000150:complications* / Q000556:secondary / Q000601:surgery; D013904:Thoracic Vertebrae; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D054854:Vertebroplasty / Q000379:methods*