Vertebral Fractures: Reliability of fracture measurements on a full spine x-ray*

In recent years there has been an increasing interest in the understanding and
prediction of global spinal balance in patients presenting with a vertebral
fracture. Especially in the aged patient, spinal balance may be impaired by
additional degenerative changes, decreased bone quality, or postural
abnormalities. Age is known to play a role in Spinal Posttraumatic Deformity
(SPTD). A vertebral fracture in older patients can lead to an anterior
displacement of the gravity mass and requires compensatory mechanisms from the
hips, lower extremities and cervical spine in order to recentralize the center
of gravity. These compensatory mechanisms, together with the unbalanced state
of the spine and the associated biomechanical changes in loading pattern, are
frequently accompanied by pain and physical impairment. The increased age of
these patients, and thus the increased predisposition to balance problems, has
led to a more frequent use of full-spine x-rays during follow-up in addition
to the targeted x-rays of the thoracic or lumbar spine.

Despite the benefits of this additional imaging, patients are often twice
exposed to radiation during the same follow-up moment. The radiation exposure
of a an AP and lateral x-ray of the lumbar- and thoracic spine is 1,5 mSv and 1
mSv resp. The radiation exposure of a full-spine series is 2.7 mSv . In
perspective, the average Dutch person is subjected to 2.9 mSv per year (of
which 1.24 mSv due to medical diagnostics). To avoid double radiation exposure,
it would be desirable to perform all measurements on the full spine radiograph.

To date, there has been no evidence of the reliability of measuring the Cobb
angle on a full spine radiograph. The purpose of this study is to compare
measurements of vertebral fractures on a focused X-ray to the same measurements
on a full-spine X-ray

Primary objective: We aim to examine whether the Cobb angle measurements are
similar on a full spine x-ray compared to a targeted x-ray, following traumatic
spinal injury in patients >55 years of age, after 3 and 12 months of
follow-up.

This study will concern a single-center prospective design, the cohort will
consist of patients (>=55 years), presenting with a spinal fracture between
02.2022 and 31-12-2022. Data will be gathered from a single hospital
(Diakonessenhuis, Utrecht). Patients eligible for inclusion will receive an
information letter and an informed consent letter and a full-spine x-ray will
be made at 3- and 12 months of follow-up duration, in addition to the targeted
X-ray.

This study is prospective in nature. We will ask patients for informed consent
at presentation to the outpatient clinic. After 3- and 12 months of follow up
the patients will undergo a targeted X-rays and full spine x-rays. The location
of the targeted x-rays will depend on the location of the fracture in the
spine. A lumbar spine x-ray will be made for a lumbar spine fracture, and a
thoracic spine x-ray will be made for a thoracic spine fracture. The cobb
angles will be measured on both the full-spine and the targeted x-rays, and
compared to each other.
The radiation exposure of a an AP and lateral x-ray of the lumbar- and
thoracic spine is 1,5 mSv and 1 mSv resp. The radiation exposure of a
full-spine series is 2.7 mSv . In perspective, the average Dutch person is
subjected to 2.9 mSv per year (of which 1.24 mSv due to medical diagnostics).
To avoid double radiation exposure, it would be desirable to perform all
measurements on the full spine radiograph.