The Effect of Disc Degeneration in Osteoporotic Vertebral Fracture

Transcription

1 Abstract The Effect of Disc Degeneration in Osteoporotic Vertebral Fracture Kyu Sung Lee, MD Department of Orthopaedic Surgery, Pochun Joongmoon Medical School Study design : Radiographic findings of vertebral fracture and disc degeneration in osteoporotic spine were observed Objectives : We investigated the relationship between osteoporotic fractures of vertebral body and disc degeneration Materials and Methods : Lumbar radiographs of 46 osteoporosis patients with vertebral fracture, ages older than 50 years were analyzed Disc degeneration was compared between the vertebral bodies with fracture and without fracture Disc degeneration and BMD were compared between three (biconcave, wedge and crush) types of vertebral fracture Result : Discs below the fractured vertebrae showed normal height without degeneration, and disc below the normal vertebrae was thin and degenerated In the comparison of disc degeneration and BMD of three types of vertebral fractures, wedge vertebral fractures showed lower BMD and severe disc degenertion than biconcave vertebral fractures Conclusion : In osteoporotic spine, fractures of vertebral bodies were more frequently occured above a disc with normal height without degeneration The vertebral bodies above a disc thined or degenerated were less susceptible to fracture Fracture of vertebral bodies above the degenerated disc showed higher incidence of wedge fracture than biconcave fracture Disc degeneration has definite relationship with the development and type of vertebral fractures in osteoporotic spine Key Words : Osteoporosis Vertebral fracture, Disc degeneratioin, BMD,, 50 Address reprint requests to Kyu Sung Lee, MD Department of Orthopaedic Surgery, College of Medicine, Pundang Cha Hospital #351, Yatap-dong, Pundang-ku, Sungnam-si, Kyongki-do, , Korea Tel : , Fax : , kyusunglee@hanmailnet

2 , 15%,, Eastell 4), 4 0;, 1; 20~25%, 2; 25~40%, 3; 40% Genant 5) Hologic QDR-4500A scaner X ( D E X A ),, ,3,4, T-score 1, , Student t test, Anova test, Chi square test, Pearson s Linear Correlation Coefficient Kellgren 12), 0;, 1;,, 2;,,, 3;,, 4 ;, 18,20) (Fig 1) Riggs 14) 20% , 70 3 ( t = , p<001) ,, 62, 2 (Kellgren score) 164, 1 34 (t=2007, p=0036) (Table 1) Fig 1 The drawing illustrates Grade of the disc degeneration and spinal osteoarthrits according to Kellgren s classification,,, (Genant )

3 Table 1 The difference of disc degeneration between the vertebral bodies with fracture and without fracture and between fracture types Score of disc degeneration N Mean SD t(p) f(p) With or without Fracture Without fracture (0036) With fracture Fracture types Without Fracture Biconcave fracture (0022) Wedge fracture Crush fracture Total Table 2 The relation between fracture types and scores of disc degeneration Grade of Kellgren disc degeneration Total 2 Without fracture 12() % 340% 319% 191% 21% 1000% Wedge fracture df=12 222% 167% 528% 28% 56% 1000% p=0000 Biconcave fracture % 323% 194% 97% 32% 1000% Crush fracture % 1000% Total % 278% 357% 113% 35% 1000% Fig 2 This box plot shows disc degeneration score of intervertebral disc of each type of vertebral fractures and without fracture Fig 3 This box plot shows bone marrow density of vertebral bodies with or without fracture (F=3260, p<005) (Table 1)

4 ( 2=3965, df=12, p<0001)(table 2) (Fig 2) 0171)(Table 4) ( r = , % 90% % (Fig 3) 5 0 %,, , ~25% (t=2785, p<001) Riggs 16) (Table 3) 20% 15% K l e e r e k o p e r 14 ),, Melton 15),,,, 4 G e n a n t 5 ),,, R e n i e r 17 ) ( r = ), (r=0608), (r=-0292) (r=0267), Harada 6 ) Table 3 Difference of bone marrow density between biconcave and wedge fracture Bone marrow density N Mean Std Dev t (P) Wedge fracture Biconcave fracture K e l l g r e nl a w r e n c e 13 ) 65 85%, 71 % Table 4 The relation between fracture types, grade of disc degenertion grade of fracture and bone mineral density in patients with vertebral fracture Fracture type Disc degeneration Fracture grade Lat BMD Fracture type - Disc degeneration Fracture grade Lateral BMD

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