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Smit T, Aage N, Haschtmann D, Ferguson SJ, Helgason B. Anatomically and mechanically conforming patient-specific spinal fusion cages designed by full-scale topology optimization. J Mech Behav Biomed Mater 2024; 159:106695. [PMID: 39186906 DOI: 10.1016/j.jmbbm.2024.106695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 08/18/2024] [Indexed: 08/28/2024]
Abstract
Cage subsidence after instrumented lumbar spinal fusion surgery remains a significant cause of treatment failure, specifically for posterior or transforaminal lumbar interbody fusion. Recent advancements in computational techniques and additive manufacturing, have enabled the development of patient-specific implants and implant optimization to specific functional targets. This study aimed to introduce a novel full-scale topology optimization formulation that takes the structural response of the adjacent bone structures into account in the optimization process. The formulation includes maximum and minimum principal strain constraints that lower strain concentrations in the adjacent vertebrae. This optimization approach resulted in anatomically and mechanically conforming spinal fusion cages. Subsidence risk was quantified in a commercial finite element solver for off-the-shelf, anatomically conforming and the optimized cages, in two representative patients. We demonstrated that the anatomically and mechanically conforming cages reduced subsidence risk by 91% compared to an off-the-shelf implant with the same footprint for a patient with normal bone quality and 54% for a patient with osteopenia. Prototypes of the optimized cage were additively manufactured and mechanically tested to evaluate the manufacturability and integrity of the design and to validate the finite element model.
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Affiliation(s)
- Thijs Smit
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland.
| | - Niels Aage
- Solid Mechanics, Technical University of Denmark, Denmark
| | - Daniel Haschtmann
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zürich, Switzerland
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Murata K, Fujibayashi S, Otsuki B, Shimizu T, Matsuda S. Low hounsfield unit values at sagittal section on computed tomography predicts vertebral fracture following short spinal fusion. J Orthop Sci 2024; 29:726-733. [PMID: 36948903 DOI: 10.1016/j.jos.2023.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Preoperative identification of osteoporosis during spine surgery is of critical importance. Additionally, the Hounsfield units (HU) measured using computed tomography (CT) have gained considerable attention. This study aimed to propose a more accurate and convenient screening method for predicting vertebral fractures after spinal fusion in elderly patients by analyzing the HU value of different range of interests of thoracolumbar spine. METHODS Our sample pool for analysis consisted of 137 elderly female patients aged >70 years who underwent one- or two-level spinal fusion surgery with a diagnosis of adult degenerative lumbar disease. The HU values of the anterior 1/3 of the vertebral bodies based on sagittal plane and those of vertebral bodies based on axial plane at T11-L5 were measured using the perioperative CT. The incidence of postoperative vertebral fractures with respect to the HU value was investigated. RESULTS Vertebral fractures were identified in 16 patients during the mean follow-up period of 3.8 years. While no significant association was found between HU value of L1 vertebral body or minimum HU value from axial plane and the incidence of the postoperative vertebral fracture, the minimum vertebral HU value of the anterior 1/3 of vertebral body from sagittal plane was associated with the incidence of the postoperative vertebral fracture. Patients with a minimum anterior 1/3 vertebral HU value of <80 had a higher incidence of postoperative vertebral fractures. The adjacent vertebral fractures occurred at the level of the vertebra with the lowest HU value, with a high probability. The existence of the vertebra with a minimum HU value of <80 within two levels of upper instrumented vertebrae was a risk factor for adjacent vertebral fracture. CONCLUSION HU measurement of the anterior 1/3 of vertebral body predicts the risk of vertebral fracture after short spinal fusion surgery.
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Affiliation(s)
- Koichi Murata
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, 606-8507, Japan.
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, 606-8507, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, 606-8507, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, 606-8507, Japan
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Murata K, Otsuki B, Shimizu T, Sono T, Fujibayashi S, Matsuda S. Sagittal Section Hounsfield Units of the Upper Instrumented Vertebrae as a Predictor of Proximal Junctional Vertebral Fractures Following Adult Spinal Deformity Surgery. Asian Spine J 2024; 18:209-217. [PMID: 38650092 PMCID: PMC11065512 DOI: 10.31616/asj.2023.0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 04/25/2024] Open
Abstract
STUDY DESIGN A retrospective observational study. PURPOSE This study aimed to determine an accurate and convenient screening method for predicting proximal junctional fractures (PJFr) following surgery for adult spinal deformity (ASD) using computed tomography (CT)-based measurement of Hounsfield units (HUs). OVERVIEW OF LITERATURE CT-based measurement of HUs is an alternative tool for assessing bone mineral density. However, the optimal method for predicting adjacent vertebral fractures following spinal fusion using HUs remains unclear. METHODS This retrospective observational study included 42 patients who underwent reconstructive surgery for ASD. Elliptical regions of interest (ROIs) on the axial section and rectangular ROIs on the sagittal section were placed at the upper instrumented vertebrae (UIV), UIV+1, and UIV+2. In addition, the HU value of the L2 vertebra was used as the representative. RESULTS PJFr occurred in 28.6% of patients within 2 years following surgery. The HU values obtained from the axial sections of L2, UIV, UIV+1, and UIV+2 were not significantly associated with the incidence of PJFr within 2 years, except for the ROI set in the lower region of the L2 vertebra. However, the HU value of the anterior third of the UIV in the sagittal section was significantly lower in the PJFr group than in the nonPJFr group (87.0 vs. 160.3, p =0.001). A UIV HU value of <100 was associated with a higher incidence of PJFr than an HU vaue of >100 (p <0.05). CONCLUSIONS Measurements of HU in the anterior one-third of the UIV in the sagittal section demonstrated predictive ability for PJFr following ASD surgery. A UIV HU value of <100 emerged as a risk factor for PJFr.
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Affiliation(s)
- Koichi Murata
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto,
Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto,
Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto,
Japan
| | - Takashi Sono
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto,
Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto,
Japan
- Department of Orthopaedic Surgery, Kijunkai Yoshikawa Hospital, Kyoto,
Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto,
Japan
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Umeda A, Murata K, Murotani Y, Fujii T, Onishi A, Murakami K, Onizawa H, Otsuki B, Shimizu T, Tanaka M, Morinobu A, Matsuda S. Low Hounsfield unit values on computed tomography as a potential predictor of vertebral fracture in patients with rheumatoid arthritis: The KURAMA cohort study. Int J Rheum Dis 2024; 27:e15146. [PMID: 38661342 DOI: 10.1111/1756-185x.15146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/12/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Hounsfield units (HU) measured using computed tomography (CT) have gained considerable attention for the detection of osteoporosis. This study aimed to investigate whether opportunistic CT could predict vertebral fractures in patients with rheumatoid arthritis (RA). METHODS A total of 233 patients with RA who underwent chest CT were included in this study. The HU values of the anterior 1/3 of the vertebral bodies based on the sagittal plane at T11-L2 after reconstruction were measured. The incidence of vertebral fractures was investigated with respect to the HU value. RESULTS Vertebral fractures were identified in 32 patients during a mean follow-up period of 3.8 years. In patients who experienced vertebral fractures within 2 years of CT imaging, the HU values of the vertebral bodies (T11-L2) were lower than those in patients who did not experience fractures. Receiver operating characteristic curve analysis identified that a T11 HU value of <125 was a risk factor for vertebral fracture within 2 years. Multivariate analysis showed that a T11 HU value of <125 and the existence of prevalent vertebral fractures were significant risk factors for fracture. CONCLUSION HU measurements of the anterior 1/3 of the vertebral body are a potential predictor for vertebral fractures in patients with RA.
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Affiliation(s)
- Akane Umeda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiki Murotani
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayuki Fujii
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Onishi
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kosaku Murakami
- Division of Clinical Immunology and Cancer Immunotherapy, Center for Cancer Immunotherapy and Immunobiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideo Onizawa
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Prado M, Khosla S, Giambini H. Vertebral Fracture Risk Thresholds from Phantom-Less Quantitative Computed Tomography-Based Finite Element Modeling Correlate to Phantom-Based Outcomes. J Clin Densitom 2024; 27:101465. [PMID: 38183962 DOI: 10.1016/j.jocd.2023.101465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Osteoporosis indicates weakened bones and heightened fracture susceptibility due to diminished bone quality. Dual-energy x-ray absorptiometry is unable to assess bone strength. Volumetric bone mineral density (vBMD) from quantitative computed tomography (QCT) has been used to establish guidelines as equivalent measurements for osteoporosis. QCT-based finite element analysis (FEA) has been implemented using calibration phantoms to establish bone strength thresholds based on the established vBMD. The primary aim was to validate vertebral failure load thresholds using a phantom-less approach with previously established thresholds, advancing a phantom-free approach for fracture risk prediction. METHODOLOGY A controlled cohort of 108 subjects (68 females) was used to validate sex-specific vertebral fracture load thresholds for normal, osteopenic, and osteoporotic subjects, obtained using a QCT/FEA-based phantom-less calibration approach and two material equations. RESULTS There were strong prediction correlations between the phantom-less and phantom-based methods (R2: 0.95 and 0.97 for males, and R2: 0.96 and 0.98 for females) based on the two equations. Bland Altman plots and paired t-tests showed no significant differences between methods. Predictions for bone strengths and thresholds using the phantom-less method matched those obtained using the phantom calibration and those previously established, with ≤4500 N (fragile) and ≥6000 N (normal) bone strength in females, and ≤6500 N (fragile) and ≥8500 N (normal) bone strength in males. CONCLUSION Phantom-less QCT-based FEA can allow for prospective and retrospective studies evaluating incidental vertebral fracture risk along the spine and their association with spine curvature and/or fracture etiology. The findings of this study further supported the application of phantom-less QCT-based FEA modeling to predict vertebral strength, aiding in identifying individuals prone to fractures. This reinforces the rationale for adopting this method as a comprehensive approach in predicting and managing fracture risk.
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Affiliation(s)
- Maria Prado
- Department of Biomedical Engineering and Chemical Engineering, One UTSA Circle, University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Sundeep Khosla
- Kogod Center on Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hugo Giambini
- Department of Biomedical Engineering and Chemical Engineering, One UTSA Circle, University of Texas at San Antonio, San Antonio, TX 78249, USA.
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Skjødt MK, Abrahamsen B. New Insights in the Pathophysiology, Epidemiology, and Response to Treatment of Osteoporotic Vertebral Fractures. J Clin Endocrinol Metab 2023; 108:e1175-e1185. [PMID: 37186550 DOI: 10.1210/clinem/dgad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
CONTEXT Vertebral fractures (VFs) make up an important but challenging group of fractures often caused by osteoporosis. Osteoporotic fractures pose unique diagnostic challenges in generally requiring imaging for diagnosis. The objective of this narrative mini-review is to provide an overview of these recent advances in our knowledge of VF pathophysiology and epidemiology with particular focus on endocrine diseases, prevention, and treatment. EVIDENCE ACQUISITION We searched PubMed on May 23, 2022, for studies of VFs in humans. Results were limited to papers available as full-text publications in English, published from 2020 and onward. This yielded 3457 citations. This was supplemented by earlier publications selected to add context to the recent findings. EVIDENCE SYNTHESIS Studies addressed VF risk in hyperthyreosis, hyperparathyroidism, acromegaly, Cushing syndrome, primary aldosteronism, and diabetes. For pharmaceutical treatment, new studies or analyses were identified for romosozumab and for weekly teriparatide. Several studies, including studies in the immediate pipeline, were intervention studies with vertebroplasty or kyphoplasty, including combination with stem cells or pharmaceuticals. CONCLUSIONS Endocrinologists should be aware of the high likelihood of osteoporotic VFs in patients with endocrine diseases. Though licensed treatments are able to substantially reduce the occurrence of VFs in patients with osteoporosis, the vast majority of recent or ongoing randomized controlled trials in the VF area focus on advanced invasive therapy of the fracture itself.
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Affiliation(s)
- Michael Kriegbaum Skjødt
- Department of Medicine 1, Holbæk Hospital, DK-4300 Holbæk, Denmark
- OPEN-Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, DK-5000 Odense, Denmark
| | - Bo Abrahamsen
- Department of Medicine 1, Holbæk Hospital, DK-4300 Holbæk, Denmark
- OPEN-Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, DK-5000 Odense, Denmark
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford OX3 7LD, UK
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Haverfield ZA, Agnew AM, Hunter RL. Differential Cortical Volumetric Bone Mineral Density within the Human Rib. J Clin Densitom 2023; 26:101358. [PMID: 36710221 DOI: 10.1016/j.jocd.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/18/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The human rib provides a vital role in the protection of thoracic contents. Rib fractures are linked to injuries and health complications that can be fatal. Current clinical methods to assess fracture risk and bone quality are insufficient to quantify intra-element differences in bone mineral density (BMD) or to identify at-risk populations. Utilizing quantitative computed tomography (QCT) provides accurate measures of volumetric BMD (vBMD) along the length of the rib which can help delineate factors influencing differential fracture risk. METHODOLOGY One mid-level rib was obtained from 54 post-mortem human subjects (PMHS) and scanned using QCT. Volumes of interest (VOIs) were created for sites at 30%, 50%, and 75% of rib total curve length. Mean Hounsfield units (HU) from each VOI were converted to vBMD using a scan-specific cortical phantom calibration curve. Additionally, rib and lumbar areal BMD (aBMD) were obtained from a sub-sample of 33 PMHS. RESULTS Significant differences in vBMD were found between all sites within the rib (p<0.01). When analyzed by sex, vBMD between the 30% and 50% site were no longer different in either males or females (p>0.05). Separating the sample into discrete age groups demonstrated the relative differences in vBMD between sites diminished with age. Further, age as a continuous variable significantly predicted rib vBMD at all sites (p<0.05), but with little practical or clinical utility (R2, 14.7- 22.8%). Similarly, only small amounts of variation in rib vBMD were explained from DXA lumbar and rib aBMD (R2 , 1.1-21.8%). CONCLUSIONS vBMD significantly decreased from the posterior (30%) site to the anterior (75%) site within the rib which may represent adaptation to localized mechanical loading. These differences could result in differential fracture risk across the rib. As thoracic injury can be fatal, using comprehensive assessments of bone quality that accounts for variation within the rib may provide more accurate identification of at-risk populations.
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Affiliation(s)
- Zachary A Haverfield
- Injury Biomechanics Research Center, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States.
| | - Amanda M Agnew
- Injury Biomechanics Research Center, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States
| | - Randee L Hunter
- Injury Biomechanics Research Center, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States
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Bai L, Li J, Ren C, Wang M, Yang F, Li Q, Zhao J, Zhang P. Cortex or cancellous-which is early for the decrease of bone content for vertebral body in health? Endocrine 2022; 78:597-604. [PMID: 36136287 DOI: 10.1007/s12020-022-03194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/03/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To obtain the cortex and cancellous parameter of the vertebral bone of healthy subjects using QCT. To explore which is earlier or faster for bone loss with age. MATERIALS AND METHODS 733 physical examiners underwent chest low-dose CT examination were recruited, from April 1, 2021 to October 1, 2021. QCT sequence was used to obtain the bone mineral density of T12-L2 vertebral body without additional radiation. The mass and area of vertebral cortex and cancellous at the central level of L2 vertebral body were measured. The age -related characteristics of vertebral cortex and cancellous between male and female was analyzed and compared. RESULTS The vBMD of T12-L2 vertebral body decreased with age. Significant differences were found in volumetric bone mineral density (vBMD) of T12-L2 vertebral body. For female, significant differences were found in bone content involving cortical mass, cancellous mass, cortical area, cancellous area, cortical mass/cancellous mass and cortical area/cancellous area in different age groups, respectively. The cortical mass decreased with age in female. The cancellous mass of female increased and then decreased with peak at 31-40 y. The cortical area of female decreased gradually before 71 y. The cancellous area of female increased and then decreased with peak at 51-60 y. The values of mass ratio and area ratio in female showed a slowly downward trend with age. Significant differences of bone content between non-menopausal and menopausal women were found except the cancellous mass. For male, no significant differences were found in all parameters of bone content. CONCLUSION The changes of vertebral BMD, bone content of cortex and cancellous have different characteristics in different age. The change of cortex in female maybe earlier and faster than that of cancellous, especially in menopausal women.
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Affiliation(s)
- Lin Bai
- Department of Radiology, Hebei Province Biomechanical Key Laboratory of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Jujia Li
- Department of Radiology, Hebei Province Biomechanical Key Laboratory of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Congcong Ren
- Department of Radiology, Hebei Province Biomechanical Key Laboratory of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Ming Wang
- Department of Radiology, Hebei Province Biomechanical Key Laboratory of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Fan Yang
- Department of Radiology, Hebei Province Biomechanical Key Laboratory of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Qian Li
- Department of Radiology, Hebei Province Biomechanical Key Laboratory of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Jian Zhao
- Department of Radiology, Hebei Province Biomechanical Key Laboratory of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
| | - Ping Zhang
- Department of Radiology, Hebei Province Biomechanical Key Laboratory of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
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Zhang Y, Zhang T, Ge X, Ma Y, Cui Z, Wu S, Liang Y, Zhu S, Li Z. A Three-Dimensional Cement Quantification Method for Decision Prediction of Vertebral Recompression after Vertebroplasty. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2330472. [PMID: 35602341 PMCID: PMC9119757 DOI: 10.1155/2022/2330472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022]
Abstract
Objective Proposing parameters to quantify cement distribution and increasing accuracy for decision prediction of vertebroplasty postoperative complication. Methods Finite element analysis was used to biomechanically assess vertebral mechanics (n = 51) after percutaneous vertebroplasty (PVP) or kyphoplasty (PKP). The vertebral space was divided into 27 portions. The numbers of cement occupied portions and numbers of cement-endplate contact portions were defined as overall distribution number (oDN) and overall endplate contact number (oEP), respectively. And cement distribution was parametrized by oDN and oEP. The determination coefficients of vertebral mechanics and parameters (R 2) can validate the correlation of proposed parameters with vertebral mechanics. Results oDN and oEP were mainly correlated with failure load (R 2 = 0.729) and stiffness (R 2 = 0.684), respectively. oDN, oEP, failure load, and stiffness had obvious difference between the PVP group and the PKP group (P < 0.05). The regional endplate contact number in the front column is most correlated with vertebral stiffness (R 2 = 0.59) among all regional parameters. Cement volume and volume fraction are not dominant factors of vertebral augmentation, and they are not suitable for postoperative fracture risk prediction. Conclusions Proposed parameters with high correlation on vertebral mechanics are promising for clinical utility. The oDN and oEP can strongly affect augmented vertebral mechanics thus is suitable for postoperative fracture risk prediction. The parameters are beneficial for decision-making process of revision surgery necessity. Parametrized methods are also favorable for surgeon's preoperative planning. The methods can be inspirational for clinical image recognition development and auxiliary diagnosis.
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Affiliation(s)
- Yanming Zhang
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Tao Zhang
- Department of Orthopedic Surgery, Tianjin First Central Hospital, Tianjin 300190, China
| | - Xiang Ge
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, Tianjin 300354, China
| | - Yong Ma
- Pain Department, The Third People's Hospital of Yunnan Province, Kunming 650010, China
| | - Zhenduo Cui
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Shuilin Wu
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Yanqin Liang
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Shengli Zhu
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Zhaoyang Li
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
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Li C, Ma C, Zhuo X, Li L, Li B, Li S, Lu WW. Focal osteoporosis defect is associated with vertebral compression fracture prevalence in a bone mineral density-independent manner. JOR Spine 2022; 5:e1195. [PMID: 35386753 PMCID: PMC8966878 DOI: 10.1002/jsp2.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/19/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Focal osteoporosis defect has shown a high association with the bone fragility and osteoporotic fracture prevalence. However, no routine computed tomography (CT)-based vertebral focal osteoporosis defect measurement and its association with vertebral compression fracture (VCF) were discussed yet. This study aimed to develop a routine CT-based measurement method for focal osteoporosis defect quantification, and to assess its association with the VCF prevalence. Materials and Methods A total of 205 cases who underwent routine CT scanning, were retrospectively reviewed and enrolled into either the VCF or the control group. The focal bone mineral content loss (focal BMC loss), measured as the cumulated demineralization within bone void space, was proposed for focal osteoporosis defect quantification. Its scan-rescan reproducibility and its correlation with trabecular bone mineral density (BMD) and apparent microarchitecture parameters were evaluated. The association between focal BMC loss and the prevalence of VCF was studied by logistic regression. Results The measurement of focal BMC loss showed high reproducibility (RMSSD = 0.011 mm, LSC = 0.030 mm, ICC = 0.97), and good correlation with focal bone volume fraction (r = 0.79, P < 0.001), trabecular bone separation (r = 0.76, P < 0.001), but poor correlation with trabecular BMD (r = 0.37, P < 0.001). The focal BMC loss was significantly higher in the fracture group than the control (1.03 ± 0.13 vs. 0.93 ± 0.11 mm; P < 0.001), and was associated with prevalent VCF (1.87, 95% CI = 1.31-2.65, P < 0.001) independent of trabecular BMD level. Discussion As a surrogate measure of focal osteoporosis defect, focal BMC Loss independently associated with the VCF prevalence. It suggests that focal osteoporosis defect is a common manifestation that positively contributed to compression fracture risk and can be quantified with routine CT using focal BMC Loss.
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Affiliation(s)
- Chentian Li
- Department of Orthopedics and TaumatologyZhujiang Hospital, Southern Medical UniversityGuangzhouGuangdongChina
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Chi Ma
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Xianglong Zhuo
- Department of OrthopaedicsLiuzhou Worker's Hospital, Guangxi Medical UniversityLiuzhouGuangxiChina
| | - Li Li
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of MedicineThe University of Hong KongHong Kong SARChina
- Department of OrthopaedicsLiuzhou Worker's Hospital, Guangxi Medical UniversityLiuzhouGuangxiChina
| | - Bing Li
- Department of OrthopaedicsLiuzhou Worker's Hospital, Guangxi Medical UniversityLiuzhouGuangxiChina
| | - Songjian Li
- Department of Orthopedics and TaumatologyZhujiang Hospital, Southern Medical UniversityGuangzhouGuangdongChina
| | - William W. Lu
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of MedicineThe University of Hong KongHong Kong SARChina
- SIAT & Shenzhen Institutes of Advanced TechnologyChinese Academy of ScienceShenzhenGuangdongChina
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11
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Kague E, Turci F, Newman E, Yang Y, Brown KR, Aglan MS, Otaify GA, Temtamy SA, Ruiz-Perez VL, Cross S, Royall CP, Witten PE, Hammond CL. 3D assessment of intervertebral disc degeneration in zebrafish identifies changes in bone density that prime disc disease. Bone Res 2021; 9:39. [PMID: 34465741 PMCID: PMC8408153 DOI: 10.1038/s41413-021-00156-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/22/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
Back pain is a common condition with a high social impact and represents a global health burden. Intervertebral disc disease (IVDD) is one of the major causes of back pain; no therapeutics are currently available to reverse this disease. The impact of bone mineral density (BMD) on IVDD has been controversial, with some studies suggesting osteoporosis as causative for IVDD and others suggesting it as protective for IVDD. Functional studies to evaluate the influence of genetic components of BMD in IVDD could highlight opportunities for drug development and repurposing. By taking a holistic 3D approach, we established an aging zebrafish model for spontaneous IVDD. Increased BMD in aging, detected by automated computational analysis, is caused by bone deformities at the endplates. However, aged zebrafish spines showed changes in bone morphology, microstructure, mineral heterogeneity, and increased fragility that resembled osteoporosis. Elements of the discs recapitulated IVDD symptoms found in humans: the intervertebral ligament (equivalent to the annulus fibrosus) showed disorganized collagen fibers and herniation, while the disc center (nucleus pulposus equivalent) showed dehydration and cellular abnormalities. We manipulated BMD in young zebrafish by mutating sp7 and cathepsin K, leading to low and high BMD, respectively. Remarkably, we detected IVDD in both groups, demonstrating that low BMD does not protect against IVDD, and we found a strong correlation between high BMD and IVDD. Deep learning was applied to high-resolution synchrotron µCT image data to analyze osteocyte 3D lacunar distribution and morphology, revealing a role of sp7 in controlling the osteocyte lacunar 3D profile. Our findings suggest potential avenues through which bone quality can be targeted to identify beneficial therapeutics for IVDD.
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Affiliation(s)
- Erika Kague
- grid.5337.20000 0004 1936 7603School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Francesco Turci
- grid.5337.20000 0004 1936 7603School of Physics, HH Wills Physics Laboratory, University of Bristol, Bristol, UK
| | - Elis Newman
- grid.5337.20000 0004 1936 7603School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Yushi Yang
- grid.5337.20000 0004 1936 7603School of Physics, HH Wills Physics Laboratory, University of Bristol, Bristol, UK ,grid.5337.20000 0004 1936 7603Centre for Nanoscience and Quantum Information, University of Bristol, Bristol, UK ,grid.5337.20000 0004 1936 7603Bristol Centre for Functional Nanomaterials, University of Bristol, Bristol, UK
| | - Kate Robson Brown
- grid.5337.20000 0004 1936 7603Department of Anthropology and Archaeology, University of Bristol, Bristol, UK ,grid.5337.20000 0004 1936 7603Department of Mechanical Engineering, University of Bristol, Bristol, UK
| | - Mona S. Aglan
- grid.419725.c0000 0001 2151 8157Clinical Genetics Department, Human Genetics and Genome Research Division, Center of Excellence for Human Genetics, National Research Centre, Cairo, Egypt
| | - Ghada A. Otaify
- grid.419725.c0000 0001 2151 8157Clinical Genetics Department, Human Genetics and Genome Research Division, Center of Excellence for Human Genetics, National Research Centre, Cairo, Egypt
| | - Samia A. Temtamy
- grid.419725.c0000 0001 2151 8157Clinical Genetics Department, Human Genetics and Genome Research Division, Center of Excellence for Human Genetics, National Research Centre, Cairo, Egypt
| | - Victor L. Ruiz-Perez
- grid.413448.e0000 0000 9314 1427Instituto de Investigaciones, Biomedicas de Madrid, and Ciber de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Stephen Cross
- grid.5337.20000 0004 1936 7603Wolfson Bioimaging Facility, Biomedical Sciences, University of Bristol, Bristol, UK
| | - C. Patrick Royall
- grid.5337.20000 0004 1936 7603School of Physics, HH Wills Physics Laboratory, University of Bristol, Bristol, UK ,grid.5337.20000 0004 1936 7603School of Chemistry, University of Bristol, Bristol, UK
| | - P. Eckhard Witten
- grid.5342.00000 0001 2069 7798Evolutionary Developmental Biology, Department of Biology, Ghent University, Ghent, Belgium
| | - Chrissy L. Hammond
- grid.5337.20000 0004 1936 7603School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
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12
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Auger JD, Frings N, Wu Y, Marty AG, Morgan EF. Trabecular Architecture and Mechanical Heterogeneity Effects on Vertebral Body Strength. Curr Osteoporos Rep 2020; 18:716-726. [PMID: 33215364 PMCID: PMC7891914 DOI: 10.1007/s11914-020-00640-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW We aimed to synthesize the recent work on the intra-vertebral heterogeneity in density, trabecular architecture and mechanical properties, its implications for fracture risk, its association with degeneration of the intervertebral discs, and its implications for implant design. RECENT FINDINGS As compared to the peripheral regions of the centrum, the central region of the vertebral body exhibits lower density and more sparse microstructure. As compared to the anterior region, the posterior region shows higher density. These variations are more pronounced in vertebrae from older persons and in those adjacent to degenerated discs. Mixed results have been reported in regard to variation along the superior-inferior axis and to relationships between the heterogeneity in density and vertebral strength and fracture risk. These discrepancies highlight that, first, despite the large amount of study of the intra-vertebral heterogeneity in microstructure, direct study of that in mechanical properties has lagged, and second, more measurements of vertebral loading are needed to understand how the heterogeneity affects distributions of stress and strain in the vertebra. These future areas of study are relevant not only to the question of spine fractures but also to the design and selection of implants for spine fusion and disc replacement. The intra-vertebral heterogeneity in microstructure and mechanical properties may be a product of mechanical adaptation as well as a key determinant of the ability of the vertebral body to withstand a given type of loading.
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Affiliation(s)
- Joshua D Auger
- Department of Mechanical Engineering, Boston University, 110 Cummington Mall, Boston, MA, 02215, USA
| | - Neilesh Frings
- Department of Biomedical Engineering, Boston University, Boston, MA, 02215, USA
| | - Yuanqiao Wu
- Department of Mechanical Engineering, Boston University, 110 Cummington Mall, Boston, MA, 02215, USA
| | - Andre Gutierrez Marty
- Department of Mechanical Engineering, Boston University, 110 Cummington Mall, Boston, MA, 02215, USA
| | - Elise F Morgan
- Department of Mechanical Engineering, Boston University, 110 Cummington Mall, Boston, MA, 02215, USA.
- Department of Biomedical Engineering, Boston University, Boston, MA, 02215, USA.
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13
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Jadzic J, Cvetkovic D, Tomanovic N, Zivkovic V, Nikolic S, Milovanovic P, Djuric M, Djonic D. The severity of hepatic disorder is related to vertebral microstructure deterioration in cadaveric donors with liver cirrhosis. Microsc Res Tech 2020; 84:840-849. [PMID: 33170963 DOI: 10.1002/jemt.23642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/26/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
Patients with liver cirrhosis (LC) commonly suffer from osteoporosis and vertebral fracture, but data about their vertebral micro-architectural changes are still limited. This study aimed to evaluate the potential differences in trabecular micro-architecture of lumbar vertebrae between male LC patients and healthy controls, in relation to etiology and pathohistological scoring of the liver disorder. After pathohistological examination of liver tissue, micro-computed tomography was performed on the vertebral samples included into: alcoholic liver cirrhosis group (ALC; n = 16; age: 59 ± 8 years), non-alcoholic liver cirrhosis group (non-ALC; n = 15; age: 69 ± 10 years) and control group (n = 16; age: 58 ± 6 years). Our data showed significant impairment of the trabecular microstructure in the lumbar vertebrae from LC donors, regardless of the alcoholic/non-alcoholic origin of liver disorder, as illustrated by lower BV/TV, Tb.Th, and Tb.N compared with controls (p < .05). Moreover, depredation in trabecular micro-architecture was inversely associated with pathohistological scores (p < .05), indicating that severity of liver disorder could be an important predictor of reduced vertebral strength in LC. We noticed significant micro-architectural deterioration in the trabecular compartment of the lumbar vertebrae of male individuals with alcoholic and non-alcoholic LC, which was associated with the severity of the liver disease. Thus, clinical assessment of fracture risk should be advised for all LC patients, regardless of the alcoholic origin of liver cirrhosis. Additionally, adequate and timely treatment of liver disorder may decelerate the progression of bone impairment in LC patients.
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Affiliation(s)
- Jelena Jadzic
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danica Cvetkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nada Tomanovic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Zivkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slobodan Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Petar Milovanovic
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Djuric
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Djonic
- Laboratory for Anthropology and Skeletal biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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14
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Jadzic J, Cvetkovic D, Milovanovic P, Tomanovic N, Zivkovic V, Nikolic S, Djuric M, Djonic D. The micro-structural analysis of lumbar vertebrae in alcoholic liver cirrhosis. Osteoporos Int 2020; 31:2209-2217. [PMID: 32577771 DOI: 10.1007/s00198-020-05509-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
UNLABELLED Although vertebral fracture is more common among alcoholic liver cirrhosis patients when compared to general population, current data on three-dimensional micro-architecture are scarce. Our study showed significant trabecular deterioration in lumbar vertebrae obtained from alcoholic liver cirrhosis donors, suggesting that they should be advised to undergo early-stage screening for osteoporosis. PURPOSE Recent studies showed an increased incidence of vertebral fractures in alcoholic liver cirrhosis (ALC) patients, while data about vertebral micro-structure are still limited. The aim of this study was to compare trabecular and cortical micro-architecture of lumbar vertebrae between ALC patients and healthy age- and sex-matched controls. METHODS Our study included lumbar vertebral samples of male cadaveric donors, divided into ALC (n = 20, age: 59 ± 6 years) and control group (n = 20, age: 59 ± 8 years). Following pathohistological verification of liver cirrhosis, trabecular and cortical bone micro-architecture was analyzed by micro-computed tomography (micro-CT). RESULTS Micro-CT evaluation of the trabecular bone in lumbar vertebrae showed a significant decrease in bone volume fraction, trabecular thickness, trabecular number, and connectivity (p < 0.01). In contrast to trabecular deterioration, prominent alteration in cortical parameters was not observed in lumbar vertebrae of ALC patients (p > 0.05). CONCLUSIONS Our data indicate that susceptibility to non-traumatic fractures in ALC patients could be explained by alterations in trabecular bone micro-architecture. Thus, we genuinely recommend osteological screening of the lumbar spine for all ALC patients in order to evaluate individual fracture risk. Graphical abstract.
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Affiliation(s)
- J Jadzic
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - D Cvetkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - P Milovanovic
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - N Tomanovic
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - V Zivkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - S Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Djuric
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - D Djonic
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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