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KMID : 0388720210280010022
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Journal of Korean Society of Spine Surgery
2021 Volume.28 No. 1 p.22 ~ p.31
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Impact of the Severity of Endplate Fracture on the Development of Intervertebral Disc Degeneration in Patients Treated with Instrumented Fusion for Unstable Traumatic Thoracic and Lumbar Fractures
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Jeon Chang-Hoon
Chung Nam-Su
Chung Hee-Woong
Lee Han-Dong
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Abstract
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Study Design: Retrospective analysis.
Objectives: To determine the impact of the severity of endplate fracture (EF) on intervertebral disc degeneration (DD) in patients treated with instrumented fusion for unstable traumatic thoracic and lumbar fractures.
Summary of Literature Review: The relationship between the severity of EF and DD has not been established.
Materials and Methods: This study analyzed 90 levels of intervertebral discs adjacent to EF and 180 adjacent vertebral endplates.
We enrolled 34 consecutive patients who had suffered a traumatic thoracic or lumbar fracture and were treated surgically. Magnetic resonance imaging (MRI) was used to assess the Pfirrmann grade of the intervertebral discs adjacent to the fractured vertebra at injury (baseline) and follow-up (mean, 16.1±3.9 months from baseline). MRI at baseline was used to evaluate the severity of EF using the total endplate defect sore (TEPS). Multivariate logistic regression analysis was used to identify independent risk factors among baseline parameters for predicting the development of DD (Pfirrmann grade ≥ III) at follow-up.
Results: All discs were grade II at baseline and changed to grade III in 20 (21.2%) discs and grade IV in 4 (4.3%) discs at follow-up. TEPS at baseline had the strongest association with the development of DD at follow-up in the analysis. Receiver operating characteristic curve analysis indicated that the optimal cut-off value of TEPS for the development of DD was 6.
Conclusions: The severity of EF at the time of the injury was associated with the development of DD. Severe EF (TEPS ≥6) at the time of the injury resulted in DD.
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KEYWORD
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Intervertebral disc degeneration, Dndplate defect, Endplate fracture, Total endplate defect score, Spinal fracture
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