osteoporotic_vertebral_compression_fracture

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osteoporotic_vertebral_compression_fracture [2024/12/31 19:32] – created - external edit 127.0.0.1osteoporotic_vertebral_compression_fracture [2025/07/01 18:19] (current) – [Case series] administrador
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 Conclusions: Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice Conclusions: Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice
 ((Joaquim AF, Bigdon SF, Bransford R, Chhabra HS, Yurac R, Kumar V, El-Sharkawi M, Benneker LM, Karamian BA, Canseco JA, Scherer J, Hassan AA, Schroeder GD, Öner CF, Rajasekaran S, Vialle E, Kanna RM, Vaccaro AR, Tee J, Camino-Willhuber G, Fisher CG, Dvorak MF, Schnake KJ; AO Spine Knowledge Forum Trauma & Infection. Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures - Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders. Global Spine J. 2024 Aug 24:21925682241278953. doi: 10.1177/21925682241278953. Epub ahead of print. PMID: 39180743.)). ((Joaquim AF, Bigdon SF, Bransford R, Chhabra HS, Yurac R, Kumar V, El-Sharkawi M, Benneker LM, Karamian BA, Canseco JA, Scherer J, Hassan AA, Schroeder GD, Öner CF, Rajasekaran S, Vialle E, Kanna RM, Vaccaro AR, Tee J, Camino-Willhuber G, Fisher CG, Dvorak MF, Schnake KJ; AO Spine Knowledge Forum Trauma & Infection. Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures - Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders. Global Spine J. 2024 Aug 24:21925682241278953. doi: 10.1177/21925682241278953. Epub ahead of print. PMID: 39180743.)).
 +===== Retrospective cohort analysis =====
 +
 +In a retrospective cohort analysis  
 +Lee et al.  
 +from Neurosurgery, Ilsan Paik Hospital, Goyang, South Korea; Clinical Research Support Center, Inje University Ilsan Paik Hospital, Goyang, South Korea  
 +published in the [[Spine Journal]]  
 +to determine whether pedicle enhancement (PE) on contrast MRI predicts progressive collapse in acute osteoporotic compression fractures (OCFs), and to correlate enhancement degree with collapse risk  
 +PE, quantified by signal-to-noise ratio (SNR ≥ 89.3), along with age, BMI, and segmental kyphosis, significantly predicts progressive collapse (AUC 0.781). Collapse risk peaks within 1–2 months, stabilizing after three months
 +((Lee BJ, Jeong S, Kim KH, Koo HW. Pedicle Enhancement on contrast-enhanced MRI As A Risk Factor for Progressive Collapse in Acute Osteoporotic Compression Fractures. Spine (Phila Pa 1976). 2025 Jul 1. doi: 10.1097/BRS.0000000000005444. Epub ahead of print. PMID: 40590204.)).
 +
 +===== Critical evaluation =====
 +
 +* **Population & design**  
 +  * Large cohort (n=203), though exclusively patients undergoing vertebroplasty (selection bias). Retrospective design limits control of confounders; level of evidence is III.  
 +  * IRB‐approved, but biopsy to confirm absence of malignancy was not routine—possible misclassification.  
 +
 +* **MRI assessment**  
 +  * SNR cutoff (89.3) yields sensitivity 71.1% and specificity 78.7%—moderate discrimination (AUC 0.781).  
 +  * Single‐center imaging, without axial MRI in most patients—may overlook key anatomical details.  
 +
 +* **Statistics & temporal trends**  
 +  * Survival (Kaplan–Meier) appropriately used to define timecourse. Notably, risk surges in first 1–2 months, plateau thereafter.  
 +  * Multivariable modelling less clear—details on variable selection, interaction, and potential overfitting lacking.  
 +
 +* **Clinical relevance**  
 +  * Identifies a measurable radiologic marker that could guide early intervention decisions.  
 +  * However, routine use of contrast MRI for all OCFs may be impractical, costly, and expose patients to Gd-based contrast risks.  
 +  * SNR threshold needs external validation; unclear whether adding PE changes management beyond standard risk factors.  
 +
 +* **Comparison with literature**  
 +  * Builds on prior recognition of pedicle enhancement/involvement in benign OCF; earlier studies warned against interpreting this only as malignancy :contentReference[oaicite:1]{index=1}.  
 +  * Advances by quantifying SNR rather than relying on qualitative assessment.  
 +
 +===== Final verdict =====  
 +Score: **6.0 / 10**  
 +The study offers a useful, quantifiable MRI biomarker and time course insight for OCF collapse risk. Yet limitations in patient selection, confirmatory pathology, and lack of external validation temper its immediate clinical adoption.
 +
 +===== Takeaway for the surgeon =====  
 +If contrast-enhanced MRI shows pedicle SNR ≥ 89.3, especially within 2 months of fracture, proactive management (bracing optimization or early vertebral augmentation) may be warranted. However, use within a broader risk stratification context and after further validation is essential.
 +
 +===== Bottom line =====  
 +Pedicle enhancement SNR is a moderate predictor of early progressive collapse in OCFs, but further prospective studies are needed before routine use.
 +
 ===== Case series ===== ===== Case series =====
  
  • osteoporotic_vertebral_compression_fracture.txt
  • Last modified: 2025/07/01 18:19
  • by administrador