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. 2011 May;8(2):38-42.

Domino Effect: mechanic factors role

Alfredo Nardi  1 , Umberto Tarantino, Lorenzo Ventura, Pierantonio Armotti, Giuseppina Resmini, Luisella Cozzi, Greta Tonini, Emilio Ramazzina, Maurizio Rossini
Affiliations

Domino Effect: mechanic factors role

Alfredo Nardi et al. Clin Cases Miner Bone Metab. 2011 May.

Abstract

The rapid onset of the Domino Effect following the first Vertebral Compression Fracture is a direct consequence of the mechanical variations that affect the spine when physiological curves are modified. The degree of kyphosis influences the intensity of the Flexor Moment; this is greater on vertebrae D7, D8 and on vertebrae D12, L1 when the spine flexes. Fractures of D7, D8, D12 and L1 are, by far, the most frequent and also the main cause of the mechanical alterations that can trigger the Domino Effect. For these considerations vertebrae D7, D8, D12 and L1 have to be taken in consideration as "critical". In the case of critical clinical vertebral fractures it is useful to provide an indication for minimally invasive surgical reduction or intrasomatic stabilization. When occurs a fracture of a "critical vertebra", prompt restoration of the heights leads to a reduction in the Kyphosis Index and therefore in the Flexor Moment, not only of the fractured vertebra but also, in turn, of all the other metameres which, even if morphologically still intact, are structurally fragile; so, through the restoration of the mechanical vertebral proprieties, we can reduce the risk of the Domino Effect. At the same time the prompt implementation of osteoinductive therapy is indispensable in order to achieve rapid and intense reconstruction of the trabecular bone, the strength of which increases significantly in a short period of time. Clinical studies are necessary to confirm the reduction of the domino effect following a fragility fracture of "critical vertebrae" with the restoration of the mechanical properties together with anabolic therapy.

Keywords: Domino Effect (DE); Flexor Moment (FM); Kyphosis Index (KI); Polymethylmethacrylate (PMMA); Vertebral Compression Fracture (VCF); Vertebral Compression Fractures (VCFs); Vertebral Deformity Degree (VDD); Vertebral Deformity Exacerbation Rate (VDER); Vertebral Deformity Gain (VDG).

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Figures

Figure 1
Figure 1
Domino Effect VCFs in rapid progression revealed by the presence of MRI signal alteration, firstly in D12 and subsequently in L1 and L2.
Figure 2
Figure 2
Mechanical pathogenesis of Domino Effect Dorsal hyperkyphosis caused by VCFs and forward shift of the center of gravity GA = gravitational axis; S = extent of shift of the center of gravity.
Figure 3
Figure 3
Kyphosis Index KI = BD/AC A = anterior superior margin T4; B = point of maximum convexity; C = anterior inferior margin T12.
Figure 4
Figure 4
Flexor moment FM = Wf x b Wf = weight force (constant); b = arm (variable).
Figure 5
Figure 5
Rapid aggravation of deformities in “critical” VCFs D8 deformity from slight to severe in 15 days following L1 fracture and D12 deformity from slight to severe in 20 days.
Figure 6
Figure 6
Restoring heights in D8 reduces the Kyphosis Index and the Flexor Moment at time T1.
Figure 7
Figure 7
VDG = Vertebral Deformity Gain Percentage value indicating the degree of correction in relation to the initial degree of the deformity.
Figure 8
Figure 8
Minimally invasive intrasomatic reduction-stabilization. old fracture of D12 and recent fractures of L1 and L2 reduction-stabilization of L2 and stabilization of L1 (the L2 fracture becomes critical owing to the collapse of D12)
See this image and copyright information in PMC

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