Spine - 2026-06-15 - Journal Article
Pedicle Enhancement on Contrast-Enhanced MRI as a Risk Factor for Progressive Collapse in Acute Osteoporotic Compression Fractures.
Lee BJ, Jeong S, Kim KH, Koo HW
Topics
Key Takeaway
Pedicle enhancement on contrast-enhanced MRI predicts progressive collapse in acute osteoporotic compression fractures, with an SNR cutoff of 89.3 yielding AUC 0.781 (71.1% sensitivity, 78.7% specificity).
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Summary
This retrospective study of 203 patients with acute osteoporotic compression fractures examined whether pedicle enhancement (PE) on contrast-enhanced MRI predicts progressive collapse. PE presence, SNR of PE, age, BMI, and segmental kyphosis were all significantly associated with progressive collapse; the optimal SNR cutoff of 89.3 achieved AUC 0.781. Kaplan-Meier analysis showed divergence between PE and non-PE groups within 1–2 months, with risk stabilizing after 3 months.
Key Limitation
The retrospective design cannot confirm that contrast-enhanced MRI was obtained uniformly or under standardized protocols across patients, introducing variability in SNR measurement and potential indication bias.
Original Abstract
STUDY DESIGN
Retrospective study.
OBJECTIVE
To verify the association between pedicle enhancement (PE) on contrast-enhanced magnetic resonance imaging (MRI) and progressive collapse, and analyze the correlation between the degree of PE and progressive collapse.
SUMMARY OF BACKGROUND DATA
Osteoporotic compression fracture (OCF) is generally considered a stable fracture, with most patients achieving successful recovery through conservative treatment such as bracing and physical therapy. However, in some cases, progressive collapse occurs, requiring additional treatment or surgery.
METHODS
We enrolled 203 patients and analyzed factors related to progressive collapse. We evaluated the association between PE and progressive collapse and determined the best cutoff value of the signal-to-noise ratio of PE (SNR of PE) for predicting progressive collapse. Survival analysis using Kaplan-Meier curve was performed to assess the cumulative risk of positive progressive collapse over time.
RESULTS
Presence of PE, SNR of PE, age, body mass index, and segmental kyphosis were significantly correlated with progressive collapse. The optimal cutoff point of SNR of PE was measured at 89.3 with 71.1% and 78.7% sensitivity and specificity, respectively, with an AUC of 0.781. Analysis of cumulative progressive collapse incidence revealed a significant difference between the PE and NPE groups within one to two months after OCF, which stabilized after three months.
CONCLUSIONS
PE is a significant predictor of progressive collapse in OCF within a year, aiding spine surgeons in risk assessment of progressive collapse and management of acute OCF.
LEVEL OF EVIDENCE
Level III.