Clinical significance of intravertebral cleft in patients with osteoporotic vertebral compression fractures

English Keywords:Osteoporotic vertebral compression fractures  Percutaneous vertebroplasty  Clinical parameters  Radiological parameters  Intravertebral cleft

English Abstract:

  【Abstract】 Objectives: To compare the clinical and radiological parameters between osteoporotic vertebral compression fractures(OVCFs) patients with or without intravertebral cleft(IVC), and to evaluate the clinical significance of IVC. Methods: The OVCFs patients consecutively treated with percutaneous vertebroplasty(PVP) between January 2016 and December 2017 in our center were retrospectively reviewed. A total of 501 patients(614 vertebrae) were enrolled, including 393 females and 108 males with a mean age of 73.1±8.3 years. Mean duration of follow-up was 29.2±14.7 months(range, 12-60 months). Based on with or without IVC, the patients were stratified into IVC group(147 patients, 163 vertebrae) and non-IVC group(354 patients, 451 vertebrae). Clinical parameters[age, gender, trauma history, body mass index(BMI), duration of symptom, fracture levels, as well as preoperative, postoperative 1d, and final follow-up visual analogue scale(VAS) score and Oswestry disability index(ODI), rate of new vertebral compression fracture, rate of new vertebral compression fracture in adjacent levels] and radiological parameters(fracture location, fracture type, compression severity, fracture range, cortical defect, spinal canal compromise, basivertebral foramen, morphology of bone cement, range of bone cement, cement leakage, cement volume, restoration rate of vertebral height, recollapse of cemented vertebrae) before and at final follow-up were recorded and compared. Results: In terms of clinical parameters, IVC group had an older age(74.3±8.2 years vs 72.2±8.9 years, P=0.016), longer duration of symptom(18.8±28.9d vs 11.3±14.4d, P=0.027), higher rate of one-level fracture(89.8% vs 74.0%, P=0.000), higher VAS score at final follow-up(2.6±0.7 vs 2.4±0.6，P=0.001), higher ODI at final follow-up[(32.5±6.7)% vs (30.9±5.8)%，P=0.011], compared to non-IVC group. In terms of radiological parameters, IVC group had a higher probability of fracture in thoracolumbar region(76.1% vs 59.0%, P=0.000), more deformed fracture(P=0.000), more severity of compression(P=0.000), more ranges of fracture (P=0.000), higher rate of cortical defect(78.5% vs 41.5%, P=0.000), higher rate of spinal canal compromise(52.1% vs 22.0%, P=0.000), lower rate of basivertebral foramen(21.5% vs 32.8%, P=0.007), higher rate of solid pattern of cement(42.3% vs 15.7%, P=0.000), lower rate of type-B cement leakage(28.8% vs 42.1%, P=0.000), lower rate of type-S cement leakage(31.3% vs 43.5%, P=0.000), higher rate of type-C cement leakage(19.0% vs 4.4%, P=0.000), higher rate of type-D cement leakage(18.4% vs 6.7%, P=0.000), higher rate of height restoration[(16.3±16.8)% vs (9.3±9.6)%, P=0.000], higher rate of recollapse of cemented vertebrae(64.4% vs 41.7%, P=0.000). Other radiological parameters were not significantly different between the two groups(P>0.05). Conclusions: OVCF IVC patients are older in age, higher in severity of compression and rate of recollapse, with a poorer long-term clinical effect after PVP when comparing with non-IVC patients.