| Objective To analyze and summarize the clinical and imaging features of osteoporotic vertebral body collapse (OVC) with neurological deficit. Methods 40 patients (35 women, 5 men; mean age 72.4 years [range 53-95 years]) with OVC were recruited from August 2010 to June 2016. According to lateral X-ray, thoracic and lumbar CT scan, MRI and the disease course, the fractures were classified into fresh and old fractures with the latter including Kummell’s disease and old fracture malunion. Furthermore, we classified the Kummell’s disease into 3 sub-types, A1 (reducible and stable type), A2 (reducible but unstable type), and B (irreducible type) based on the image of extending CT scan. In addition, we described the vertebral body collapse degree and shape with the concept of mild, moderate, severe and very severe type. The very severe type included three sub-types, flat, wedged and concave. Clinical symptoms, VAS, ASIA grade, physical signs and bone material density were recorded. The most severe vertebral body collapse degree, the thoracolumbar Cobb angle, and the occupied rate of the posterior bony fragment to spinal canal were measured from X-ray, CT and MRI. Results The main clinical symptom was back pain in 38/40 patients (95%). Leg and intercostal radicular pain was observed in 19/40 (47.5%) and 22/40 (55%) patients, respectively. Urinary dysfunction and perineal numbness was observed in 2 patients and bilateral groin pain in 2 patients. The VAS for back pain and radicular pain ranged from 0 to 8 and 3 to 8, with an average value of 6.6 and 5.8, respectively. According to the ASIA grade, 5 were graded as C (12.5%), 10 as D (25%) and 25 as E (62.5%). The average BMD T-score was -3.5 SD. Regarding to the morphology characteristic, there were 30/46 Kummell’s disease (65.2%) (A2 type 56.7%, B type 26.7% and A1 type 16.7%), 13 were fresh fracture, and 3 were old malunion. The cleft was found from CT scan of 28 vertebrae. 34/46 vertebrae were very severe collapse type (50% wedged, 32.4% concave and 17.6% flat), 9/46 were severe collapse, and 3/46 were moderate and none was mild type. 36/46 vertebrae were located in the thoracolumbar segment and 25/36 thoracolumbar Cobb angle was over 30°. There were 7 vertebrae distributed in the lower lumbar spine and 3 in thoracic spine. 30 vertebral collapses resulted in central canal stenosis and 10 with foraminal stenosis. Conclusions The main symptom was back pain, with mild to moderate neurological deficits which manifested mostly as leg and/or intercostal radicular pain, some originated from dynamic nerve compression. In addition, some patients presented urinary dysfunction and perineal numbness. The main type of vertebral body collapse was Kummell’s disease (mainly A2 type, followed by B type) and very severe fracture (wedged sub-type), mostly distributed at the thoracolumbar level, with severe thoracolumbar kyphosis and osteoporosis, and intravertebral cleft seen on the CT scan, resulting in more canal stenosis than foraminal stenosis. |