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Neuroradiology

Vertebral collapse

breakdown of a vertebra resulting in a decreased height of its body. The collapse may occur to a variable extent and in more severe cases it may be associated with an increased width of the body with possible bulging of the posterior wall towards the spinal canal and consequent spinal cord or nerve root compression. A vertebral breakdown is, of course, observed in traumatic contexts but the term collapse usually applies more properly to spontaneous nontraumatic occurrences. In spontaneous collapse an underlying condition such as a primary osseous disease or secondary replacement by tumours is responsible for a weakening of the vertrebral osseous structure. Spontaneous vertebral collapse may be clinically apparent and may be responsible for an overwhelming, acute paralyzing backpain syndrome. The observation of a collapsed vertebral body as an incidental finding is not infrequent in clinical radiological practice.

While the diagnosis of vertebral collapse is easily accomplished with plain X-ray films, it may be harder to identify the cause and in particular to differentiate benign osteoporotic vertebral collapse from tumoral replacement. Evidence of osteoporosis may be documented on plain films as multiple vertebral deformities leading to a biconcave appearance of the intervertebral discs and osseous demineralization.

CT may show specific evidences of tumoral replacement such as osseous lysis in the cortical areas and excessive soft tissue along the vertebral walls. In the absence of such signs the diagnosis of tumoral replacement is harder but still cannot be excluded.

MRI easily differentiates on the basis of signal intensities between the two conditions in the setting of chronic vertebral collapse. An osteoporotic collapsed vertebral body demonstrates a similar signal intensity to normal vertebrae, whereas replaced vertebral body appears to be of lower signal intensity on short TR images. In more acute cases, the distinction between the two causes is more difficult because both may display a low signal; this is due to the low signal of marrow oedema in non-neoplastic causes and to tumour itself in neoplasms. In some cases of acute benign osteoporotic collapse, incomplete signal loss is seen. An even band of normal high-signal marrow with smooth margins may remain adjacent to a band of lower signal in the same vertebral body. This appearance is suggestive of a non-neoplastic deformity. By contrast, an extension of the low T1-signal intensity into the vertebral peduncles is believed to be evidence of tumoral replacement.

FS