Study of the effect of fracture features on adjacent discdegeneration in the treatment of vertebra fractures

AIM: Disc degeneration may develop after vertebral fractures and may cause pain and kyphotic deformity in patients. Although there are many studies on vertebral fractures, there are fewer studies examining the effects of fracture variables on the development of disc degeneration. In this study, it was aimed to examine the development of disc degeneration and the factors affecting it in patients who were treated surgically and whose implants were removed and followed for a long time and in patients who were treated conservatively. Materials & Methods: This study is a cross-sectional study. Patients who applied to our hospital between 2006 and 2017 due to thoracic and lumbar vertebral fractures were included in the study. Inclusion criteria; having appropriate direct X-ray or computed tomography examination at the time of admission, patients having implants removed for non-infectious reasons after surgical treatment or patients undergoing conservative treatment, being in the age group of 14-99, having the appropriate number of direct X-rays in controls. Exclusion criteria: less than 2 years of follow-up, tumor, and infection or no history of trauma, anterior intervention or kyphoplasty, patients with AO type A0. In the study, fracture level, AO fracture type, endplate fracture characteristics, classification and amount of fragmentation, sagittal index measurement, measurement of the height of the discs adjacent to the fracture level, and detection of degeneration with the Akeda method were performed, and the time of arrival for the control was noted. Patient age at the time of fracture (groups: <30y, 30-60y, >60y), gender, fracture level, fracture type, endplate fracture characteristics, treatment method, time after fracture (groups: 2-3 years, 4-5 years, >5 years) on the development of disc degeneration was measured. Statistical analyzes were performed using SPSS 24.0, chi-square, and Fisher test. Ethics committee approval was obtained for the study. Results:109 fractured vertebrae of 91 patients were included in the study. The follow-up period of the patients was between 2 and 15 years (mean 4.6 years). In our study, the rate of disc degeneration after vertebral fracture was found to be 31.63% in total. Disc degeneration was mostly seen in the 30-60 age group, in cranial discs, both endplate fractures and surgically treated and implanted group, and it was found to be less common between T11-L1. Disc degeneration in adjacent segments after 5 years was determined to be more common. This result was found to be statistically significant. The limitations of the study are the absence of magnetic resonance examination, the inability to correlate with clinical data due to the retrospective analysis, and the irregularity of control intervals. Conclusion: In this study, it was observed that disc degeneration is more common in cranial discs and in cases where endplate fragmentation is high after vertebral fractures. It was found that degeneration was significantly more common after 5 years following the fracture.