S-Space College of Medicine/School of Medicine (의과대학/대학원) Orthopedic Surgery (정형외과학전공) Journal Papers (저널논문_정형외과학전공)
Usefulness of prone cross-table lateral radiographs in vertebral compression fractures
- Cho, Jae Hwan; Shin, Sang Ik; Lee, Jae Hyup; Yeom, Jin Sup; Chang, Bong-Soon; Lee, Choon-Ki
- Issue Date
- Korean Orthopaedic Association
- Clinics in Orthopedic Surgery, vol.5, pp. 195-201
- Prone lateral radiograph; Vertebroplasty; Kyphoplasty; Osteoporosis; Vertebral fracture; Intravertebral cleft
- This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
- Background: Dynamic radiographs are recommended to investigate non-healing evidence such as the dynamic mobility or intravertebral
clefts in osteoporotic vertebral compression fractures (VCFs). However, it is difficult to examine standing flexion and
extension lateral radiographs due to severe pain. The use of prone cross-table lateral radiographs (PrLRs) as a diagnostic tool has
never been proposed to our knowledge. The purpose of this study is to clarify the usefulness of PrLRs in diagnosis and treatment
Methods: We reviewed 62 VCF patients examined with PrLRs between January 1, 2008 and June 30, 2011. To compare the degree
of pain provoked between standing extension lateral radiographs (StLRs) and PrLRs, numeric rating scale (NRS) scores were
assessed and compared by a paired t-test. Vertebroplasty was done for 40 patients and kyphoplasty was done for 9 patients with
routine manners. To assess the degree of postural reduction, vertebral wedge angles (VWA) and vertebral height ratios (VHR) were
calculated by using preoperative StLRs, PrLRs, and postoperative lateral radiographs. Two variables derived from changes in VWA
and VHR between preoperative and postoperative radiographs were compared by a paired t-test.
Results: The average NRS scores were 6.23 ± 1.67 in StLRs and 5.18 ± 1.47 in PrLRs. The degree of pain provocation was lower
in using PrLRs than StLRs (p < 0.001). The average changes of VWA between preoperative and postoperative status were 5.24°
± 6.16° with PrLRs and 3.46° ± 3.47° with StLRs. The average changes of VHR were 0.248 ± 0.178 with PrLRs and 0.148 ± 0.161
with StLRs. The comparisons by two variables showed significant differences for both parameters (p = 0.021 and p < 0.001, respectively).
The postoperative radiological status was reflected more precisely when using PrLRs than StLRs.
Conclusions: In comparison with StLR, the PrLR was more accurate in predicting the degree of restoration of postoperative vertebral
heights and wedge angles, and provoked less pain during examination. The PrLR could be a useful diagnostic tool to detect
intravertebral cleft or intravertebral dynamic instability.
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