Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2009 Sep;16(3):153-159. Korean.
    Published online Sep 29, 2009.
    https://doi.org/10.4184/jkss.2009.16.3.153
    Copyright © 2009 Korean Society of Spine Surgery
    Original Article

    Risk Factors for the Progressive Osteoporotic Spinal Fracture

    Jong-Min Sohn, M.D., Ki-Won Kim, M.D.,* Kee-Yong Ha, M.D.,# Nan-Kyoung Ha, M.D., Young-Hoon Kim, M.D., and Ju-Hwan Kim, M.D.
      • Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.
      • *Department of Orthopedic Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.
      • #Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.
    • Address reprint requests to: Young-Hoon Kim, M.D. Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea #665-8, Bupyeong-6Dong, Bupyeong-Gu, Incheon, 403-720, Korea. Tel: 82-32-510-5512, Fax: 82-32-505-7795, Email: boscoa@empal.com
    Received January 06, 2009; Accepted July 29, 2009.

    Abstract

    Study Design

    Retrospective risk-factor analysis

    Objectives

    This study investigated the clinical and radiological risk factors associated with the progression of osteoporotic spinal fractures (OSFs) after conservative treatment.

    Summary of the Literature Review

    Nonunion and cleft signs on radiographs are strongly associated with complicated osteoporotic spinal fractures.

    Materials and Methods

    From Jan. 2005 to Dec. 2007, 84 patients (15 males and 69 females; mean 72.6 yrs) were enrolled in this retrospective review. The progressive OSF, clinical and radiological factors were analyzed considering the progression of the kyphotic angle (PKA>20°) and the presence of intravertebral cleft signs (IVC). Age, gender, body mass index, vertebral level involved, BMD score, MRI classification and initial kyphotic angle were adopted for the analysis. For statistical analysis, a chi-square test was performed to analyze the relationship between each factor and multiple logistic regression analysis was performed to analyze the multifactorial explanatory factor.

    Results

    The presence of IVC was related to the thoracolumbar fracture, mid-portion MR classification and high body mass index. PKA>20° was related to the thoracolumbar fracture and mid-portion classification. For multifactorial analysis using these seven factors, two factors (the level of fracture and MR classification) were found to be associated with the presence of IVC with statistical significance. In the thoracolumbar fracture, the incidence of IVC was 5.2 times higher than the other levels. The incidence of IVC in endplate classification was 16% lower than in the mid-portion.

    Conclusion

    BMI, the fracture level involved and MR classification were associated with the development of IVC and PKA>20° for a conservative treatment of OSF. Multiple logistic analysis revealed the level of the fracture and MR classification to be significant.

    Keywords
    Osteoporosis; Spinal fracture; Nonunion; Risk factors

    Figures

    Fig. 1
    A case of complicated osteoporotic compression fracture. A 65-year-old woman suffered from intractable back and flank pain and progressive weakness of the lower extremities. She underwent anterior decompression and fusion surgery.

    Fig. 2
    MRI characteristics of osteoporotic compression fracture. (A) The cases with findings of signal change around the endplate and disruption of endplate are classified as an endplate type. (B) The cases with findings of signal change at the mid-portion of vertebral body and disruption of anterior cortex are classified as a mid-portion type.

    Tables

    Table 1
    Baseline characteristics of all the patients enrolled

    Table 2
    Results obtained from analysis for multiple accessed factors

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    MeSH Terms
    Body Mass Index
    Humans
    Incidence
    Logistic Models
    Male
    Osteoporosis
    Retrospective Studies
    Risk Factors
    Spinal Fractures
    Metrics
    Share
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