Injury to the Vertebral Endplate-Disk Complex Associated with Osteoporotic Vertebral Compression Fractures.
Summary of "Injury to the Vertebral Endplate-Disk Complex Associated with Osteoporotic Vertebral Compression Fractures."
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. MATERIALS AND
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.
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.
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.
Department of Radiology, Winthrop University Hospital, Mineola, New York.
This article was published in the following journal.
Name: AJNR. American journal of neuroradiology
Medical and Biotech [MESH] Definitions
Intervertebral Disk Degeneration
Degenerative changes in the INTERVERTEBRAL DISK due to aging or structural damage, especially to the vertebral end-plates.
Optic Neuropathy, Ischemic
Ischemic injury to the OPTIC NERVE which usually affects the OPTIC DISK (optic neuropathy, anterior ischemic) and less frequently the retrobulbar portion of the nerve (optic neuropathy, posterior ischemic). The injury results from occlusion of arterial blood supply which may result from TEMPORAL ARTERITIS; ATHEROSCLEROSIS; COLLAGEN DISEASES; EMBOLISM; DIABETES MELLITUS; and other conditions. The disease primarily occurs in the sixth decade or later and presents with the sudden onset of painless and usually severe monocular visual loss. Anterior ischemic optic neuropathy also features optic disk edema with microhemorrhages. The optic disk appears normal in posterior ischemic optic neuropathy. (Glaser, Neuro-Ophthalmology, 2nd ed, p135)
The specialized postsynaptic region of a muscle cell. The motor endplate is immediately across the synaptic cleft from the presynaptic axon terminal. Among its anatomical specializations are junctional folds which harbor a high density of cholinergic receptors.
Intervertebral Disk Chemolysis
The dissolving of the nucleus pulposus, the semi-gelatinous tissue of a displaced INTERVERTEBRAL DISK. It is usually achieved by the direct injection of a proteolytic enzyme, especially CHYMOPAPAIN, into the herniated disk.
Vertebral Artery Dissection
Splitting of the vessel wall in the VERTEBRAL ARTERY. Interstitial hemorrhage into the media of the vessel wall can lead to occlusion of the vertebral artery, aneurysm formation, or THROMBOEMBOLISM. Vertebral artery dissection is often associated with TRAUMA and injuries to the head-neck region but can occur spontaneously.
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