Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Does the quality and the quantity of posterior paraspinal muscles increase the risk of symptomatic intravertebral vacuum cleft sign following vertebral compression fracture at the thoracolumbar junction? (#1)

Joonghyun Ahn 1 , Seunghun Ha 1 , Young H Kim 2 , Gang-Un Kim 3 , Kee Y Ha 4
  1. Orthopedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyunggi-do, Repulibc of Korea
  2. Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic university of Korea, Seoul, Republic of Korea
  3. Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
  4. Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Repulic of Korea

INTRODUCTION

 

The causes of the symptomatic intravertebral vacuum cleft (SIVC) with pain or spinal kyphosis after vertebral compression fractures are unclear so far, but long-term steroid use, osteoporosis, and pancreatitis have been reported, and the mechanism is known to be caused by impaired blood flow to the fractured vertebra or instability of the fracture site. However, few studies have investigated risk factors including features of paraspinal muscles that progress to SIVC by specifying a compression fracture at the thoracolumbar junction. This study aimed to investigate whether the quality (fat infiltration, FI) and quantity (cross-sectional area, CSA) of paraspinal muscles (erector spinae, multifidus) at the fractured vertebral segment were risk factors for progression to symptomatic intravertebral vacuum cleft (SIVC).

 

 METHODS

Between March 2013 and February 2023, 726 consecutive patients diagnosed with vertebral compression fracture at our institution, who were examined by plain radiographs and magnetic resonance images (MRI), were included in this study.

 

SIVC was defined as a patient with 1) pain caused by fracture is not alleviated after 3 months of trauma and 2) an intravertebral vacuum cleft or a pseudomotion in the body of the fractured vertebra in thoracolumbar lateral radiographs. The baseline demographics, the characteristics obtained from the initial radiographs (level, initial compression ratio, and kyphotic angle), and information measured by MRI at diagnosis (CSA and FI of the erector spinae and multifidus muscles on the axial surface of the fracture site of the T2 weighted image) were collected, and then, univariate analysis and multivariate logistic regression analysis was conducted to determine whether SIVC occurred by these variables.

 

RESULTS

SIVC developed in 43 (5.92%) out of 726. On univariate analysis between non-SIVC and SIVC patients, statistical differences were found in age, relative CSA of ES, FI of MF and ES, compression ratio, initial Cobb angle of fractured vertebra (p<0.05). On logistic regression analysis,

severe (>50%) FI of MF (OR 1987441.4, p<0.001), severe (>50%) FI of ES (OR 10860.9, p<0.001), and relative ES (OR 3.72, p=0.009) showed statistical significance.

 

 Discussion

Severe (>50%) fat infiltration in the multifidus and erector spinae muscle at the fracture site were considered independent risk factors for vertebral compression fracture at thoracolumbar junction progressing to SIVC. However, other variables such as age, osteoporosis, initial radiographic compression ratio of fracture, and initial vertebral Cobb angle of fracture were not statistically significant.