• Atsushi Terakado, Sumihisa Orita, Kazuhide Inage, Go Kubota, Tomohiro Kanzaki, Hiroshi Mori, Yuji Shinohara, Junichi Nakamura, Yusuke Matsuura, Yasuchika Aoki, Takeo Furuya, Masao Koda, and Seiji Ohtori.
• Kitachiba Spine and Sports Clinic, Chiba, Japan.
• Pain Res Manag. 2017 Jan 1; 2017: 9265259.

BackgroundElderly female patients complaints of acute low back pain (LBP) may involve vertebral fracture (VF), among which occult VF (OVF: early-stage VF without any morphological change) is often missed to be detected by primary X-ray examination. The current study aimed to investigate the prevalence of VF and OVF and the diagnostic accuracy of the initial X-ray in detecting OVF.MethodSubjects were elderly women (>70 years old) complaining of acute LBP with an accurate onset date. Subjects underwent lumbar X-ray, magnetic resonance imaging (MRI), and bone mineral density (BMD) measurement at their first visit. The distribution of radiological findings from X-ray and magnetic resonance imaging (MRI) as well as the calculation of the prevalence of VF and OVF are investigated.ResultsThe prevalence of VF among elderly women with LBP was 76.5% and L1 was the most commonly injured level. Among VF cases, the prevalence of OVF was 33.3%. Furthermore, osteoporotic patients tend to show increased prevalence of VF (87.5%). The predictive values in detecting VF on the initial plain X-ray were as follows: sensitivity, 51.3%; specificity, 75.0%; and accuracy rate, 56.7%.ConclusionsAcute LBP patients may suffer vertebral injury with almost no morphologic change in X-ray, which can be detected using MRI.

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