gms | German Medical Science

Objectives: Traumatic vertebral compression fractures (tVCFs) and osteoporotic vertebral fractures (OVFs) are common injuries. Concomitant intervertebral disc lesions are believed to increase the risk for early degeneration in these patients. However, little is known about the incidence and severity of disc injuries in these fractures. Thus, the aim of this study was to assess the frequency of sustained concomitant disc injuries in the above fractures and to correlate severity with fracture severity.

Methods: All patients treated with the SpineJack^®-system and preoperative MR-imaging from Nov 2014 to Dec 2022 were assessed. 408 intervertebral discs (204 superior and 204 inferior; 204 fractures) were analyzed. Demographics, fracture characteristics (AO Spine A1-4 and OF-classification) and adjacent disc injury severity according to Sander et al. based on MR-imaging were analyzed. To assess differences in disc injury severity (ordinal data) between groups (nominal data) the Mann-Whitney-U test was used. Correlation analysis between ordinal and ordinal data was performed using Spearman's correlation coefficient, whereas to assess correlation between ordinal and nominal data, Pearson’s correlation was used.

Results and conclusion: The mean age of the assessed cohort was 63.1 years (50.5% female) with ahigher mean age in OVFs (p=<0.001). Of all assessed fractures (58.3% OVFs), 139 had an injury to the superior adjacent disc (68.1%) and 119 (58.3%) to the inferior adjacent disc. Amongst all assessed discs, 150 were not injured (grade 0), 72 had an edema (grade 1), 106 had an intradiscal tear (grade 2) and 80 showed an infraction into vertebral body/annular tear (grade 3). More superior disc injuries were assessed in OVFs (p=0.047). Injury to both discs were observed in 110 fractures with no difference between sex and OVFs vs. tVCFs. We assessed a positive correlation between inferior disc injury severity and neurology at admission (p=0.041). No correlation between superior disc injury but a negative correlation between inferior disc injury and intraoperative cement leakage was assessed amongst all fractures (p=0.015). Inferior discs were more severely injured in OVFs (p=0.012) but no difference in superior disc injuries between the groups was assessed. (p=0.059). There was no correlation between OF-classification and superior disc injury severity (p=0.798) and inferior disc injury severity (p=0.314). We assessed a positive correlation between AO Spine-classification and inferior disc injury severity (p=0.023) but no correlation was found with superior disc injury severity (p=0.240). Intervertebral disc injuries in tVCFs and OVFs are common concomitant injuries with a higher incident of superior disc injuries in OVFs. Inferior disc injury seems to be associated with less cement leakage but more neurological symptoms. More severe tVCFs are associated with more severe inferior disc injuries. Further studies should assess the long-term outcome of patients with concomitant disc injury.