Vertebral-body collapse in focal and diffuse disease: Patterns of pathologic processes

The radiographic patterns of vertebral-body collapse and/or endplate deformity were examined in 99 autopsy specimens of the thoracolumbar spine with benign and malignant disease. Angling of endplates was found to be highly predictive of underlying malignancy, whereas concavity was more suggestive of benign disease, for both individual vertebral bodies and intact spines (P < .001). Diffuse-concave, diffuse-angled, and focal-angled patterns were more useful (P < .001) than the focal-concave pattern (P = .07) in distinguishing between benign and malignant disease for superior endplates, whereas all were equally useful (P < .025) in inferior endplates. Condition of the adjacent disks, location within the spine, and position of the apex of collapse were not predictive. Although these results and subsequent blinded testing suggest that reliable distinction between benign and malignant vertebral collapse is possible, extrapolation to clinical practice may be inappropriate because of population bias in the study and differences in radiographic quality between autopsy specimens and live subjects.