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Radiographic outcome of vertebral bone bruise associated with fracture of the thoracic and lumbar spine in adults

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Bone bruising associated with long bone injury is a defined entity with known radiological, pathologic and clinical features. Vertebral bone bruise (VBB) has been described through magnetic resonance imaging (MRI) of the injured spine, but to date the consequences of this entity are unknown. The objective of this retrospective study was to describe the plain radiographic outcome of MRI-defined VBB associated with thoracic and lumbar spine fracture in adults, and to assess whether VBBs caused abnormalities of the bone-implant interface at instrumented levels. Levels of VBB were identified through analysis of the full spine MRI in a consecutive series of adult patients admitted to a spinal injuries unit for thoracic and lumbar spine fractures. The anterior wedge angles (AWAs) of thoracic and lumbar vertebrae demonstrating VBB were measured on radiographs taken at time of injury and at follow-up. Abnormalities of the bone--implant interface were recorded at instrumented levels associated with VBB on follow-up radiographs. Thirty VBBs were identified in 18 adult patients who had suffered 21 vertebral fractures. At an average follow-up of 19 months (range, 12--30 months), the mean AWAs of the VBB vertebrae at the time of injury and at the most recent follow-up were 3.5 degrees and 3.8 degrees , respectively (p=0.33, paired t-test). A total of 12 out of 30 (40%) bruised levels were instrumented in 13 out of 18 (72%) operated patients. No bone--implant interface failure was observed at these levels. It is concluded that VBB associated with thoracic and lumbar vertebral fracture in adult patients does not appear to cause significant progressive vertebral deformity or bone--implant interface failure.
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Introduction
Bone bruises, also known as trabecular microfractures,
are defined on magnetic resona nce imaging (MRI) as
band-like or diffuse zones of high signal intensity on T2-
weighted sequences and decreased signal intensity on
T1-weighted sequences, without associated fracture of
the cortex [2]. In the knee, the most frequent mechanism
of generation of bone bruises is an axial compression
load. Signs of subchondral damage resolve on MRI
within 2–4 months from injury, but their long-term ef-
fect on joint function is not clear [11]. Bone bruises
affecting the vertebral bodies can be associated with
spinal injury [5]. However, to our knowledge, the plain
radiographic sequelae of vertebral bone bruises (VBB)
have not been described yet.
Marco Teli
Nick de Roeck
Maxim D. Horowitz
Asif Saifuddin
Ruth Green
Hilali Noordeen
Radiographic outcome of vertebral bone
bruise associated with fracture of the thoracic
and lumbar spine in adults
Received: 10 October 2003
Revised: 28 June 2004
Accepted: 15 July 2004
Published online: 28 September 2004
Ó Springer-Verlag 2004
Abstract Bone bruising associated
with long bone injury is a defined
entity with known radiologic al,
pathologic and clinical features.
Vertebral bone bruise (VBB) has
been described through magnetic
resonance imaging (MRI) of the in-
jured spine, but to date the conse-
quences of this entity are unknown.
The objective of this retrospective
study was to describe the plain
radiographic outcome of MRI-de-
fined VBB associated with thoracic
and lumbar spine fracture in adults,
and to assess whether VBBs caused
abnormalities of the bone–implant
interface at instrumented levels.
Levels of VBB were identified
through analysis of the full spine
MRI in a consecutive series of adult
patients admitted to a spinal injuries
unit for thoracic and lumbar spine
fractures. The anterior wedge angles
(AWAs) of thoracic and lumbar
vertebrae demonstrating VBB were
measured on radiographs taken at
time of injury and at follow-up.
Abnormalities of the bone–implant
interface were recorded at instru-
mented levels associated with VBB
on follow-up radiographs. Thir ty
VBBs were identified in 18 adult
patients who had suffered 21 verte-
bral fractures. At an average follow-
up of 19 months (range, 12–
30 months), the mean AWAs of the
VBB vertebrae at the time of injur y
and at the most recen t follow-up
were 3.5° and 3.8°, respectively
(p=0.33, paired t-test). A total of 12
out of 30 (40%) bruised levels were
instrumented in 13 out of 18 (72%)
operated patients. No bone–implant
interface failure was observed at
these levels. It is concluded that VBB
associated with thoracic and lumbar
vertebral fracture in adult patients
does not appear to cause significant
progressive vertebral deformity or
bone–implant interface failure.
Keywords Bone bruise Æ Trabecular
microfracture Æ Spinal injury Æ MRI
Eur Spine J (2005) 14: 541–545
DOI 10.1007/s00586-004-0786-1
ORIGINAL ARTICLE
M. Teli Æ N. de Roeck
M. D. Horowitz Æ A. Saifuddin
R. Green Æ H. Noordeen
Royal National Orthopaedic Hospital
NHS Trust, Stanmore, UK
M. Teli (&)
Spinal Deformity Unit,
Galeazzi Orthopaedic Institute,
Via Galeazzi 4, 20161 Milan, Italy
E-mail: marcoteli@hotmail.com
Tel.: +39-02-66214911
Fax: +39-02-66214911
N. de Roeck Æ M. D. Horowitz
H. Noordeen
Spinal Deformity Unit,
Royal National Orthopaedic Hospital,
Brockley Hill, Stanmore, HA7 4LP, UK
A. Saifuddin Æ R. Green
Musculoskeletal Radiology Department,
Royal National Orthopaedic Hospital,
Brockley Hill, Stanmore,
HA7 4LP, UK
Histological analysis of bone bruises identified in the
knee has shown that microfractures occur in the can-
cellous bone [13]. Trabecular microfractures have also
been observed at autopsy in 67% of thoracic spine
specimens retrieved after blunt trauma fatalities [16]. In
theory, similar findings in spinal trauma patients could
render a vertebral body liable to deformity and
compromise the fixation if a bone-bruised vertebra were
instrumented.
MRI of the injured spine offers the benefit of exam-
ining all potentially traumatised structures, namely the
vertebrae, the intervertebral disc, the ligaments and
the neural tissue [14, 17]. This helps in determining the
management of these patients and, if chosen, the
appropriate method of surgical stabilisa tion [12, 14, 17].
All patients admitted to our spinal injuries unit undergo
full spine MRI, enabling us to identify those who have
sustained VBB in addition to their thoracic or lumbar
fractures.
This study was designed to establish the plain
radiographic outc ome of bone-bruised vertebrae in
terms of segmental deformity, by comparing the anterior
wedge angle (AWA), [4, 8] at injury and follow-up, in
adult patients who have sustained thoracic and/or lum-
bar spine fractures. Secondly, we wished to assess if the
presence of bone bruise compromised the use of surgical
instrumentation within affected vertebral levels, by
recording any abnormal ity at the bone–implant interface
on follow-up radiographs.
Materials and methods
Cases were obtained from a prospective database of
whole spine MRI for patients prese nting to a regional
spinal injuries unit with a spinal fracture. The total
number of patients on this database was 127. The
findings on whole spine MRI in this patient group have
been published separately. From this study, the overall
incidence of VBB was 57% [3]. Inclusion criteria were
defined as follows: patients were adults referred to our
spinal injuries unit with a thoracic and/or lumbar
vertebral fracture, plus one or more vertebral bone
bruises identified in the thoracic and/or lumbar spine
on a full spine MRI obtained at the time of ad mission.
VBB levels were defined according to the criteria de-
scribed in the introduction. The sequences used were:
sagittal T1-weighted spin echo; sagittal fat-saturated
T2-weighted fast spin echo (which highlight bone oe-
dema) and axial T1-weighted spin echo sequences at,
above and below the vertebral fracture level [4, 14, 17].
The remainder of the spine was imaged with a sagittal
fat-suppressed T2-weighted fast spin echo sequence, in
order to identify occult non-contiguous injuries. Pa-
tients had to have completed a minimum follow-up of
1 year and undergone plain radiography of both the
fractured and bone-bruised levels at the time of injury
and latest follow-up.
From the database we identified a consecutive series
of 18 patients matching these criteria. An orthopaedic
trainee, a spinal fellow and a consultant radiologist who
had not been involved in the treatment of the patients
reviewed the imaging of each patient. We assessed the
MRI from the time of injury to identify the appropriate
level or levels of bone bruise (Fig. 1a). With a pocket
goniometer, we then measured the AWA of the bone-
bruised vertebrae on lateral spinal radiographs taken at
the time of the injury and erect lateral radiographs from
the most recent follow-up (Fig. 1b and c).
Measurements of AWA were made independently by
two observers and interobserver reliability assessed
using the kappa statistic. A paired Student’s t-test was
performed to compare the mean AWA at the time of
injury with that of the most recent follow-up. The sag-
ittal index (SI-ratio of posterior vertebral body height to
anterior vertebral body height) was also calculat ed for
each of the bone-bruised vertebrae at presentation and
at final follow-up. The difference in mean SI at time of
injury and at time of follow-up was assessed using a
paired Student’s t-test. Finally, we analysed the outcome
of the instrumentation. Failure of the bone–implant
interface was defined as the presence of screw or hook
change of position (back-out, dislodgement) or any bone
abnormality (radiolucency, fracture) around the instru-
mentation on follow-up radiographs (Fig. 1a–c).
Results
Eighteen patients who had been admitted consecutively
to our spinal injuries unit for thoracic and lumbar spine
fractures over a period of 3 years (from 1998 to 2000)
matched the inclusion criteria of the study. These pa-
tients, 15 men and three women, were aged 38 years on
average (range, 19–75). The mean interval from the time
of injury to the most recent follow-up was 19 months
(range, 12–30 months). None of these patients was lost
to follow-up.
Table 1 displays the number, type and levels of ver-
tebral fractures and vertebral bone bruises (VBBs) in the
corresponding patients. Patients had sustained a total of
21 fractures of the thoracic and lumbar spine, associated
with 30 bone-bruised vertebrae overall. Therefore, 30 of
285 non-fractured thoracic and lumbar vertebrae dis-
played VBB, giving a frequency of 10.5%. According to
the comprehensive classification [9], A3 fracture types
(burst fractures) were most common, being observed in
15 out of 21 cases (12 patients). While fractures pre-
vailed at L1 (seven out of 21 levels), VBBs were equally
predominant at T9, T10 and T12 (four per each level)
but were distributed throughout the entire thoracic and
lumbar spine, with the exception of T3, T7 and L5. A
542
single VBB was observed in most of the patients (seven
out of 18), two in five patients, three in two patients and
four in one patient only.
Table 2 displays the radiological measurements con-
cerning the bone-bruised levels. Interobserver concor-
dance for AW A measurements between observers 1 and
2 for radiographs at presentation was k=0.957 (excel-
lent agreement) and for radiographs at final follow-up
was k=0.939 (excellent agreement). The mean AWA of
vertebrae associated with VBB at the time of injury was
3.5° (SD, 2.3°; range, 0–7°). At the time of the most
recent follow-up, the mean AWA of the same vertebrae
was 3.8° (SD, 2.2°; range, 0–7°). The difference (0.3°) for
these normally distributed data was not statistically
significant (p=0.33 at t-test). Of the 30 VBB levels, eight
(27%) showed an increase in AWA from injury to fol-
low-up averaging 2° (range, 1–3°), 15 (50%) showed no
change in AWA and seven (33%) showed a negative
difference of )1° to )2°. The mean SI at time of injury
was 1.105 and at final follow-up was 1.118. This differ-
ence was found to be not significant (p=0.59).
Of the 18 patients studied, 13 (72%) underwent
surgical stabilisation, all with pedicle screws. In
Fig. 1 a Sagittal fat-suppressed T1 W fast spin echo MRI showing
vertebral bone bruise at L3, associated with an A3 (burst) fracture
at L4 (Patient No. 17). b Lateral radiograph at time of injury
showing an AWA of 2° at level of bone bruise. c Lateral radiograph
at 30 months follow-up showing an AWA of 2° at level of bone
bruise. No detectable bone–implant interface abnormality
Table 1 Patient details (VBB
vertebral bone bruise)
Patient No. Gender Age Follow-up
(months)
Fracture
type [8]
Fracture
levels (n=21)
VBBs (n=30)
1 Male 26 12 B3 T8 T1
2 Male 51 21 B2 T4 T2
3 Female 70 19 B2 T8 T4
4 Male 24 20 A3 T7 T4, T5
5 Male 48 17 A3 T7, T8 T6
6 Male 38 16 A3 T7 T8
7 Male 21 19 B2 T12 T10, T11, L1
8 Male 57 21 A3 T12, L1 T9, T10, T11
9 Female 24 20 B1 L1 T9, T10, T12
10 Male 48 17 A3 T11 T9, T10
11 Male 33 19 A3 L1 T9, T11, T12
12 Male 35 15 A3 L1 T12, L2
13 Male 19 21 A3 T11 T12, L1
14 Female 19 20 A3 L2 L1
15 Male 19 15 A3 L1 L2
16 Male 33 17 A3 L1, L4 L3
17 Male 69 30 B3 L4 L3
18 Male 75 20 A3 L1 L4
543
addition, four patients had anterior reconstruction with
a titanium cage. Of these 13 patients, nine (69%) had
instrumentation placed into a bone-bruised level. In
total, 12 of the 30 (40%) assessed bruised vertebrae
were instrumented. On follow-up radiographs, a Steffee
plate was noted to have fractured in a 21-year-old male
patient, 12 months after he had sustained a B2 (flexion-
distraction) fracture of T12. This fracture had been
treated by posterior instrumentation via placement of
pedicle screws at T10, T11 and L1. On the MRI scan
taken on admission to hospital, all of these levels were
noted to have been affected by VBB, but on follow-up
radiographs none of the implanted screws showed signs
of change of position, nor was any radiolucency de-
tected around the screws.
On examination of the follow-up spine radiographs
of all the patients, we detected no evidence of failure of
the bone–implant interface according to the above-de-
scribed criteria.
Discussion
Bone-bruise following trauma has been well described
in MRI studies of the knee [11] and ankle [6]. The
radiological outcome of bone bruise is that the
abnormality resolves within 2–4 months [1, 11], with a
good clinical outcome, provided no other articular
structures have been injured [18]. We aimed to inves-
tigate the effects of bone bruises on the bony spine,
although we suffered the limitations typical of any
retrospective study. In particular, in our public health-
based institution we could not obtain funding to per-
form follow-up MRI scans, which might have helped to
define a time frame for the evolution of bone bruises in
the vertebral marrow, as it has been the case for the
knee [11, 18].
In the present study, a minimum follow-up of
12 months was thought to be sufficient for the conse-
quences of VBB to reach a steady state, based on the
above-reported findings in long bone trauma. At the
final follow-up, 27% of bone-bruised vertebrae did show
a2° increase an d 33% a 1–2° decrease in the average
AWA from injury to follow-up, but the mean difference
of +0.3 ° in AWA from injury to follow-up was not
significant at t-test. It is, therefore, likely that the posi-
tive and negative differences in AWAs from injury to
follow-up fall within the accuracy range of radiographic
measurement described in the Materials and methods
section above.
Patients were all skeletally mature with a broad age
range, ranging from young adults to elderly individuals.
It was not possible to speculate on the effects of age and
correlated morbidities on wedgi ng of the bruised levels,
because bone mineral density is not routinely studied in
patients admitted for spinal trauma. Also, the effect of
bone bruise on the immature vertebra remains to be
investigated.
Post-traumatic kyphosis, the main parameter corre-
lating with the clinical outcome of thoracic and lumbar
fractures in both conservatively and surgically treated
patients, is a multifactorial event depending on degree of
vertebral body comminution, posterior ligament com-
plex injury [12] and possibly disc injury [14]. Because this
study aime d to define the segmental radiographic out-
come of vertebral bone bruise, we avoided investigating
any variation in the sagittal plane deformity of our
patients from injury to follow-up.
As all patients treated within our unit are tertiary
referrals, the majority of patients in this series were
surgically stabilised, having sustained predominantly
type A3 (burst) fractures, along with a number of type
B1 and B2 (flexion-distraction) and type B3 (hyperex-
tension-shear) fractures [9]. Surgery was performed by
anterior, posterior or combined approaches, depending
on the severity of the injury and the structures involved
[10]. A single implant failure occurred in the above-
described patient, who suffered a type-B2 fracture of
T12 and was treated by posterior instrumentation via
insertion of pedicle screws at three adjacent bone-
bruised levels and interconnectin g plates. One of the
Table 2 Radiographic measurements (observer 1) (VBB vertebral
bone bruise, AWA anterior wedge angles)
VBB No. Injury AWA Follow-up AWA Difference
17 7 0
20 0 0
33 5 2
44 3 )1
52 2 0
61 1 0
76 6 0
86 6 0
92 0 )2
10 5 5 0
11 5 4 )1
12 0 0 0
13 0 3 3
14 5 6 1
15 8 7 )1
16 5 5 0
17 3 2 )1
18 2 5 3
19 3 2 )1
20 7 5 )2
21 6 6 0
22 3 5 2
23 0 0 0
24 2 3 1
25 3 5 2
26 3 3 0
27 5 5 0
28 4 4 0
29 0 2 2
30 6 6 0
544
Steffee plates fractured, but the pedicle screws remained
intact. Such a failure mode has been described by the
designers of the implant [15], and we believe it is not
attributable to the instrumentation of bone-bruised
vertebrae.
On examination of the follow-up radiograph s of all
patients, there was no evidence of screw or hook
back-out or dislodgement, nor of radiolucency or
fracture around the instrumentation. Thus, at follow-
up, no bone-implant failure appeared to have occurred
at instrumented bruised levels. We believe the abse nce
of a follow-up computed tomography (CT) scan did
not limit the accuracy of this analysis, as CT does not
seem to provide higher accuracy than plain radio-
graphs in detecting abnormalities of the bone–implant
interface in spinal trauma patients [7].
Conclusions
Based on the results of this study, we suggest that bon e
bruises within a thoracic or lumbar vertebral body in
adult patients do not cause significant vertebral wedging
and so are not, in isolation, a risk factor for post-trau-
matic deformity. We also feel that bone bruises do not
compromise placement of instrumentation within af-
fected vertebrae. Therefore, the benign outcome of bone
bruise in the vertebral body seems to replicate the out-
come described in long bones, despite the peculiar ana-
tomic and biomechanical features of the bony spine.
Acknowledgement We thank Marco Brayda-Bruno MD, Senior
Consultant, Spinal Deformity Unit, Galeazzi Orthopaedic Insti-
tute, Via Galeazzi 4, 20161, Milan, Italy, for his advice regarding
this manuscript
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545
... The traumatic VBB is usually treated with conservative methods [3,5]. The conservative treatment is based on the progression of traumatic VBB. ...
... The conservative treatment is based on the progression of traumatic VBB. However, there has been only one study about the progression of traumatic VBB in adult patients [5]. ...
... Like edema in the joint, the traumatic VBB in the spine showed a similar progression in a few studies [5][6][7]. The VBB on the MRI findings were retrospectively evaluated by the radiographs in the eighteen adult patients aged 38 years on average (range, 19-75) with thoracic and lumbar spine fractures, and the effect of the VBB on bone-implant abnormalities at the instrumented levels was also elucidated [5]. ...
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Article
Background Advances in magnetic resonance imaging (MRI) have made it possible to find the vertebral body bruise (VBB), which was not found in computed tomography (CT) after trauma. There has been only one study with adult patients about whether traumatic VBB will cause a collapse of the vertebral body or not. The purpose is to elucidate the progression of VBB in non-osteoporotic adult patients and to identify the possible factors influencing the progression. Method The VBB was defined on MRI as band-like or diffuse zones of high signal intensity on T2-weighted sequences without fracture of the cortex based on CT. The study population with traumatic VBB associated with non-osteoporotic spinal fracture was composed of 15 females and 21 males. The minimal follow-up period was 6 months. The ratio of anterior to posterior heights of the VBB, the ratio of anterior heights of the VBB to the average of those of cranial and caudal adjacent vertebral bodies, the anterior wedge angle of the VBB, and the focal angle around the VBB were compared between the initial and final visits. We evaluated the age of the patients, the C2 plumb line distance, the regional location of VBB, the etiology of VBB, and the treatment methods of the fractures as possible risk factors influencing the progression. Results There was no difference in the ratios and angles between the initial and final visits. The differences in the ratios and angles between the initial and final visits were not dependent on the possible risk factors. The anterior superior area is the most common in the distribution of VBB. Conclusions Unlike compression fractures, the vertebral body with traumatic VBB found in adult patients with non-osteoporotic spinal fractures of AO classification A or B types did not develop collapse. In clinical practice, it is reasonable to diagnose it as a spinal fracture rather than a VBB if the collapse of a possible VBB occurs.
... Bone bruises/contusions, also known as trabecular microfractures, are defined on magnetic resonance imaging (MRI) as band-like or diffuse zones of high signal intensity on T2-weighted sequences or short TI inversion recovery (STIR), and decreased signal intensity on T1-weighted sequences, without associated fracture of the cortex. [1] A histological analysis of bone bruises of the knee showed that microfractures occur in the cancellous bone and trabecular microfractures were observed at autopsy in 67% of thoracic spine specimens retrieved after blunt trauma fatalities. [1] Clinically, spinal MRI often detects additional vertebral bone bruises in blunt trauma patients with negative spinal computed tomography (CT) images. ...
... [1] A histological analysis of bone bruises of the knee showed that microfractures occur in the cancellous bone and trabecular microfractures were observed at autopsy in 67% of thoracic spine specimens retrieved after blunt trauma fatalities. [1] Clinically, spinal MRI often detects additional vertebral bone bruises in blunt trauma patients with negative spinal computed tomography (CT) images. [2,3,4] However, the radiographic sequelae of vertebral bone bruises have not been well described. ...
... [2][3][4] In contrast to these studies, Teli et al. performed a retrospective study that described the plain radiographic outcomes of MRI-defined vertebral bone bruises associated with thoracic and lumbar spine fracture in adults, and assessed whether the vertebral bone bruises caused abnormalities of the bone-implant interface at instrumented levels. [1] The levels of the vertebral bone bruises in a consecutive series of adult patients who were admitted to a spinal injuries unit for thoracic and lumbar spine fractures were identified through an analysis of full spine MRI. As a result, 30 vertebral bone bruises were identified in 18 adult patients (male, n=15; female, n=3; average age, 38 years [range, 19-75 years]). ...
... Для оценки результатов лечения авторы использовали данные клинического осмотра и контрольного МРТ: ни у одного пациента не было отмечено нарушения функции позвоночного столба или развития посттравматической деформации. Teli et al. [14] также не смогли выявить значимых посттравматических изменений у 30 взрослых пациентов, получивших ушиб тел позвонков. Данные результаты позволяют считать такие повреждения безопасными в плане прогноза и не требующими комплексного лечения. ...
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Objective. To analyze the efficacy of various methods for treatment of children with compression fractures of the thoracic and lumbar spine on the basis of literature data. Material and Methods. A systematic review of the literature on methods for the diagnosis and treatment of compression fractures of the spine in children was carried out. PubMed, Science Direct, and Google Scholar databases were searched for literature sources for analysis. Results. A significant number of discrepancies between the approaches used in the treatment of compression fractures in children and the available literature data were noted. In particular, not any diagnostic protocol includes MRI as a tool to confirm the presence of a fracture, due to the high cost of the method and its low influence on the treatment tactic choice. The data of biomechanical studies cast doubt on the feasibility of long-term bed rest compliance and restrictions on sitting. As for bracing of patients with compression fractures, it has been demonstrated that wearing of rigid brace does not allow achieving better results in comparison with its absence. The child’s ability to remodel residual deformations of vertebral bodies ensures the restoration of their height and shape in the vast majority of cases. Currently, there is no data confirming the fact of earlier development of degenerative diseases and back pain in children who sustained compression vertebral fractures. Conclusion. The review results allow to analyze the efficacy of various treatment methods and can be the basis for reviewing the existing treatment tactics for children with compression fractures of the vertebral bodies.
... Teli et al. identi ed 30 VBBs in 285 nonfractured thoracic and lumbar vertebrae in adults, associated with 21 fractures of other vertebrae. ey also noted that VBB within a thoracic or lumbar vertebral body did not cause signi cant vertebral wedging in adults [7]. 2 Case Reports in Orthopedics e low incidence of spinal column injuries in children is mainly attributed to the anatomic characteristics of the axial skeleton in childhood. ...
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Vertebral bone bruise (VBB) in children commonly occurs following a fall from a height, and more than one vertebral body may be affected. We encountered 6 children each with a single VBB caused by mild physical activity. All the children had tenderness on the corresponding spinous process with no neurologic findings. Magnetic resonance imaging (MRI) showed typical findings of VBB in all cases. The children were treated conservatively with a soft thoracolumbar brace and instructed to rest with no physical activity for a month. At follow-up 1 month later, the back pain had diminished, and the signal changes seen on MRI had disappeared in all cases. We conclude that mild physical activity may be a cause of VBB in children and good clinical results can be achieved by using a soft thoracolumbar brace and rest.
... Vertebral bone bruise (VBB), also known as trabecular microfractures, is defined on MRI as BME without the associated fracture of the cortex [20]. At a follow-up of 19 months study, VBB with vertebral fracture does not appear to cause significant progressive vertebral deformity, and 3 of 30 VFs in 18 patients remained no col- lapse [21]. A follow-up the study of Pham T et al. (1), 4 of 21 VFs in 16 patients remained normal. ...
... Subchondral bone contusion (bone bruise, trabecular microfracture) has been accepted as the most common type of secondary lesion. In the spine, subchondral bone contusions are observed on MRI scans as band-like or diffuse zones of high signal intensity on T2 weighted sequences, and decreased signal intensity on T1 weighted sequences (13,14). The pattern of bone contusions is regarded as a footprint, left behind at the site of the injury in the peripheral joint (15), with the mechanism of injury understood by studying the distribution of the edema (15,16). ...
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