The mechanism of thoracolumbar burst fracture may be related to the basivertebral foramen

Xuyang Zhang, Shengyun Li, Xing Zhao, Blaine A Christiansen, Jian Chen, Shunwu Fan, Fengdong Zhao

Research output: Contribution to journalArticle

Abstract

Background Context: The basivertebral foramen (BF), located in the middle posterior wall of the vertebral body, may induce local weakness and contribute to the formation of a retropulsed bone fragment (RBF) in thoracolumbar burst fracture (TLBF). We hypothesize that the mechanism of TLBF is related to the BF. Purpose: This study aimed to clarify the relationship between RBFs and the BF in TLBFs, and to explain the results using biomechanical experiments and micro-computed tomography (micro-CT). Study Design: A comprehensive research involving clinical radiology, micro-CT, and biomechanical experiments on cadaveric spines was carried out. Patient Sample: A total of 162 consecutive patients diagnosed with TLBF with RBFs, drawn from 256 patients who had reported accidents or injuries to their thoracolumbar spine, comprised the patient sample. Outcome Measures: Dimensions and location of the RBFs in relation to the BF were the outcome measures. Materials and Methods: Computed tomography reconstruction imaging was used to measure the dimensions and location of RBFs in 162 patients (length, height, width of RBF and vertebral body). Furthermore, micro-CT scans were obtained of 10 cadaveric spines. Each vertebral body was divided into three layers (superior, middle, and inferior), and each layer was divided further into nine regions (R1-R9). Microarchitecture parameters were calculated from micro-CT scans, including bone volume fraction (BV/TV), connectivity (Conn.D), trabecular number (Tb.N), trabecular thickness (Tb.Th), and bone mineral density (BMD). Differences were analyzed between regions and layers. Burst fractures were simulated on cadaveric spines to explore the fracture line location and test the relationship between RBFs and BF. Results: Retropulsed bone fragment width was usually one-third of the width of the vertebral body, whereas RBF length and height were approximately half of the corresponding vertebral body dimensions. Measures of trabecular bone quality were generally lowest in those central and superior regions of the vertebral body which are adjacent to the BF and which are most affected by burst fracture. In simulated TLBFs, the fracture line went across the vertex or upper surface of the BF. Conclusions: The most vulnerable regions in the vertebral body lie within or just superior to the BF. The central MR2 region in particular is at risk of fracture and RBF formation.

Original languageEnglish (US)
JournalSpine Journal
DOIs
StateAccepted/In press - 2017

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Tomography
Bone and Bones
Spine
Outcome Assessment (Health Care)
Body Regions
Radiology
Osteogenesis
Bone Density
Accidents
Wounds and Injuries
Research
Cancellous Bone

Keywords

  • Basivertebral foramen
  • Biomechanical experiment
  • Microarchitecture
  • Retropulsed bone fragment
  • Thoracolumbar burst fracture
  • Vertebral body

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The mechanism of thoracolumbar burst fracture may be related to the basivertebral foramen. / Zhang, Xuyang; Li, Shengyun; Zhao, Xing; Christiansen, Blaine A; Chen, Jian; Fan, Shunwu; Zhao, Fengdong.

In: Spine Journal, 2017.

Research output: Contribution to journalArticle

Zhang, Xuyang ; Li, Shengyun ; Zhao, Xing ; Christiansen, Blaine A ; Chen, Jian ; Fan, Shunwu ; Zhao, Fengdong. / The mechanism of thoracolumbar burst fracture may be related to the basivertebral foramen. In: Spine Journal. 2017.
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abstract = "Background Context: The basivertebral foramen (BF), located in the middle posterior wall of the vertebral body, may induce local weakness and contribute to the formation of a retropulsed bone fragment (RBF) in thoracolumbar burst fracture (TLBF). We hypothesize that the mechanism of TLBF is related to the BF. Purpose: This study aimed to clarify the relationship between RBFs and the BF in TLBFs, and to explain the results using biomechanical experiments and micro-computed tomography (micro-CT). Study Design: A comprehensive research involving clinical radiology, micro-CT, and biomechanical experiments on cadaveric spines was carried out. Patient Sample: A total of 162 consecutive patients diagnosed with TLBF with RBFs, drawn from 256 patients who had reported accidents or injuries to their thoracolumbar spine, comprised the patient sample. Outcome Measures: Dimensions and location of the RBFs in relation to the BF were the outcome measures. Materials and Methods: Computed tomography reconstruction imaging was used to measure the dimensions and location of RBFs in 162 patients (length, height, width of RBF and vertebral body). Furthermore, micro-CT scans were obtained of 10 cadaveric spines. Each vertebral body was divided into three layers (superior, middle, and inferior), and each layer was divided further into nine regions (R1-R9). Microarchitecture parameters were calculated from micro-CT scans, including bone volume fraction (BV/TV), connectivity (Conn.D), trabecular number (Tb.N), trabecular thickness (Tb.Th), and bone mineral density (BMD). Differences were analyzed between regions and layers. Burst fractures were simulated on cadaveric spines to explore the fracture line location and test the relationship between RBFs and BF. Results: Retropulsed bone fragment width was usually one-third of the width of the vertebral body, whereas RBF length and height were approximately half of the corresponding vertebral body dimensions. Measures of trabecular bone quality were generally lowest in those central and superior regions of the vertebral body which are adjacent to the BF and which are most affected by burst fracture. In simulated TLBFs, the fracture line went across the vertex or upper surface of the BF. Conclusions: The most vulnerable regions in the vertebral body lie within or just superior to the BF. The central MR2 region in particular is at risk of fracture and RBF formation.",
keywords = "Basivertebral foramen, Biomechanical experiment, Microarchitecture, Retropulsed bone fragment, Thoracolumbar burst fracture, Vertebral body",
author = "Xuyang Zhang and Shengyun Li and Xing Zhao and Christiansen, {Blaine A} and Jian Chen and Shunwu Fan and Fengdong Zhao",
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T1 - The mechanism of thoracolumbar burst fracture may be related to the basivertebral foramen

AU - Zhang, Xuyang

AU - Li, Shengyun

AU - Zhao, Xing

AU - Christiansen, Blaine A

AU - Chen, Jian

AU - Fan, Shunwu

AU - Zhao, Fengdong

PY - 2017

Y1 - 2017

N2 - Background Context: The basivertebral foramen (BF), located in the middle posterior wall of the vertebral body, may induce local weakness and contribute to the formation of a retropulsed bone fragment (RBF) in thoracolumbar burst fracture (TLBF). We hypothesize that the mechanism of TLBF is related to the BF. Purpose: This study aimed to clarify the relationship between RBFs and the BF in TLBFs, and to explain the results using biomechanical experiments and micro-computed tomography (micro-CT). Study Design: A comprehensive research involving clinical radiology, micro-CT, and biomechanical experiments on cadaveric spines was carried out. Patient Sample: A total of 162 consecutive patients diagnosed with TLBF with RBFs, drawn from 256 patients who had reported accidents or injuries to their thoracolumbar spine, comprised the patient sample. Outcome Measures: Dimensions and location of the RBFs in relation to the BF were the outcome measures. Materials and Methods: Computed tomography reconstruction imaging was used to measure the dimensions and location of RBFs in 162 patients (length, height, width of RBF and vertebral body). Furthermore, micro-CT scans were obtained of 10 cadaveric spines. Each vertebral body was divided into three layers (superior, middle, and inferior), and each layer was divided further into nine regions (R1-R9). Microarchitecture parameters were calculated from micro-CT scans, including bone volume fraction (BV/TV), connectivity (Conn.D), trabecular number (Tb.N), trabecular thickness (Tb.Th), and bone mineral density (BMD). Differences were analyzed between regions and layers. Burst fractures were simulated on cadaveric spines to explore the fracture line location and test the relationship between RBFs and BF. Results: Retropulsed bone fragment width was usually one-third of the width of the vertebral body, whereas RBF length and height were approximately half of the corresponding vertebral body dimensions. Measures of trabecular bone quality were generally lowest in those central and superior regions of the vertebral body which are adjacent to the BF and which are most affected by burst fracture. In simulated TLBFs, the fracture line went across the vertex or upper surface of the BF. Conclusions: The most vulnerable regions in the vertebral body lie within or just superior to the BF. The central MR2 region in particular is at risk of fracture and RBF formation.

AB - Background Context: The basivertebral foramen (BF), located in the middle posterior wall of the vertebral body, may induce local weakness and contribute to the formation of a retropulsed bone fragment (RBF) in thoracolumbar burst fracture (TLBF). We hypothesize that the mechanism of TLBF is related to the BF. Purpose: This study aimed to clarify the relationship between RBFs and the BF in TLBFs, and to explain the results using biomechanical experiments and micro-computed tomography (micro-CT). Study Design: A comprehensive research involving clinical radiology, micro-CT, and biomechanical experiments on cadaveric spines was carried out. Patient Sample: A total of 162 consecutive patients diagnosed with TLBF with RBFs, drawn from 256 patients who had reported accidents or injuries to their thoracolumbar spine, comprised the patient sample. Outcome Measures: Dimensions and location of the RBFs in relation to the BF were the outcome measures. Materials and Methods: Computed tomography reconstruction imaging was used to measure the dimensions and location of RBFs in 162 patients (length, height, width of RBF and vertebral body). Furthermore, micro-CT scans were obtained of 10 cadaveric spines. Each vertebral body was divided into three layers (superior, middle, and inferior), and each layer was divided further into nine regions (R1-R9). Microarchitecture parameters were calculated from micro-CT scans, including bone volume fraction (BV/TV), connectivity (Conn.D), trabecular number (Tb.N), trabecular thickness (Tb.Th), and bone mineral density (BMD). Differences were analyzed between regions and layers. Burst fractures were simulated on cadaveric spines to explore the fracture line location and test the relationship between RBFs and BF. Results: Retropulsed bone fragment width was usually one-third of the width of the vertebral body, whereas RBF length and height were approximately half of the corresponding vertebral body dimensions. Measures of trabecular bone quality were generally lowest in those central and superior regions of the vertebral body which are adjacent to the BF and which are most affected by burst fracture. In simulated TLBFs, the fracture line went across the vertex or upper surface of the BF. Conclusions: The most vulnerable regions in the vertebral body lie within or just superior to the BF. The central MR2 region in particular is at risk of fracture and RBF formation.

KW - Basivertebral foramen

KW - Biomechanical experiment

KW - Microarchitecture

KW - Retropulsed bone fragment

KW - Thoracolumbar burst fracture

KW - Vertebral body

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