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Fushimi K, Miyagawa T, Iwai C, Nozawa S, Iinuma N, Tanaka R, Shirai G, Tanahashi H, Yokoi T, Akiyama H. Transforaminal Lumbar Interbody Fusion with Double Banana Cages: Clinical Evaluations and Finite Element Model Analysis. Global Spine J 2024; 14:2031-2038. [PMID: 36944178 PMCID: PMC11418724 DOI: 10.1177/21925682231165709] [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] [Indexed: 03/23/2023] Open
Abstract
STUDY DESIGN Clinical and basic study. OBJECTIVES This study aimed to investigate whether transforaminal lumbar interbody fusion (TLIF) using 2 banana-shaped cages leads to good clinical outcomes. METHODS First, we conducted a clinical study to compare outcomes among patients who underwent TLIF using different types or numbers of cages. Propensity matched patients in each group were reviewed. Thirty-four patients who underwent surgery with 2 bullet-shaped cages (group A), 34 with a banana-shaped cage (group B), and 34 with 2 banana-shaped cages (group C) were compared. Twelve months after the surgery, bony fusion and cage subsidence were evaluated. RESULTS The mean amount of cage subsidence was 14.9% in group A, 19.9% in group B, and 11.8% in group C. Subsidence in group B was significantly greater than that in group C (P < .01). Radiological bony fusion was not achieved in 2 cases in group B. Second, we performed a finite element model (FEM) analysis to determine the biomechanical stress of the vertebral endplate by comparing the single-banana cage construct with a double banana-shaped cage construct. FEM analysis showed that the maximum stress of the endplate in the single-cage model was 1.72-times greater than the maximum stress in the double-cage model. Furthermore, the maximal stress in the single-cage model was significantly higher than in the double-cage model during lumbar extension and side bending. CONCLUSION This study showed that TLIF with double banana-shaped cages led to good clinical outcomes with less cage subsidence, probably because of decreased mechanical stress on the vertebral endplate.
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Affiliation(s)
- Kazunari Fushimi
- Department of Orthopaedic Surgery, Spine Surgery Center, Gifu Prefectural General Medical Center, Gifu, Japan
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takaki Miyagawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Chizuo Iwai
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Satoshi Nozawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Nobuki Iinuma
- Department of Orthopaedic Surgery, Spine Surgery Center, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Ryo Tanaka
- Department of Orthopaedic Surgery, Spine Surgery Center, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Goshi Shirai
- Department of Orthopaedic Surgery, Spine Surgery Center, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Hiroyuki Tanahashi
- Department of Orthopaedic Surgery, Spine Surgery Center, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Tatsuo Yokoi
- Department of Orthopaedic Surgery, Spine Surgery Center, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Yang X, Zhang S, Su J, Guo S, Ibrahim Y, Zhang K, Tian Y, Wang L, Yuan S, Liu X. Comparison of Clinical and Radiographic Outcomes Between Transforaminal Endoscopic Lumbar Discectomy and Microdiscectomy: A Follow-up Exceeding 5 Years. Neurospine 2024; 21:303-313. [PMID: 38317550 PMCID: PMC10992631 DOI: 10.14245/ns.2347026.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To compare the long-term clinical and radiographic outcomes of transforaminal endoscopic lumbar discectomy (TELD) versus microdiscectomy (MD). METHODS The data of 154 patients with lumbar disc herniation (LDH) who underwent TELD (n = 89) or MD (n = 65) were retrospectively analyzed. The patients' clinical outcomes were evaluated using visual analogue scales for leg and low back pain, the Japanese Orthopaedic Association (JOA) score, and the Oswestry Disability Index (ODI). The evolution of radiographic manifestations was observed during follow-up. Potential risk factors for a poor clinical outcome were investigated. RESULTS During a mean follow-up of 5.5 years (range, 5-7 years), the recurrence rate was 4.49% in the TELD group and 1.54% in the MD group. All scores significantly improved from preoperatively to postoperatively in both groups (p < 0.01). The improvement in the ODI and JOA scores was significantly greater in the TELD than MD group (p < 0.05). Forty-seven patients (52.8%) in the TELD group and 32 (49.2%) in the MD group had Modic changes before surgery, most of which showed no changes at the last follow-up. The degeneration grades of 292 discs (71.0%) were unchanged at the last follow-up, while 86 (20.9%) showed improvement, mostly at the upper adjacent segment. No significant difference was observed in the intervertebral height index or paraspinal muscle-disc ratio. CONCLUSION Both TELD and MD provide generally satisfactory long-term clinical outcomes for patients with LDH. TELD can be used as a reliable alternative to MD with less surgical trauma. Modic type II changes, decreased preoperative intervertebral height, and a high body mass index are predictors of a poor prognosis.
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Affiliation(s)
- Xinyu Yang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shijun Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Junxiao Su
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Sai Guo
- Photography Department, School of Journalism and Communication, Tianjin Normal University, Tianjin, China
| | - Yakubu Ibrahim
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Kai Zhang
- Department of Orthopedics, The Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
- Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Liu X, Zhao T, Sun C, Shi H, Shi J, Shi G, Hou Y. Evaluation and analysis of surgical treatment for single-level or multi-level lumbar degenerative disease based on radiography. Quant Imaging Med Surg 2024; 14:1441-1450. [PMID: 38415163 PMCID: PMC10895145 DOI: 10.21037/qims-23-1108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/05/2023] [Indexed: 02/29/2024]
Abstract
Background Radiography has a low level of radiation exposure while providing valuable information. Due to its cost effectiveness and widespread availability, the preoperative radiographic imaging examination is a valuable approach for assessing patients with spinal disease. This study aimed to examine the influence of preoperative X-ray evaluation on the surgical treatment of patients with single- or multi-level lumbar degenerative disease (LDD). Methods A retrospective cohort analysis was conducted of 172 patients diagnosed with LDD who underwent transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) surgery between December 2021 and February 2023 at the Shanghai Changzheng Hospital. Various parameters were measured on preoperative radiographs, including the iliac crest height, median iliac angle (MIA), lumbar lordosis (LL), intervertebral facet joint degeneration, lumbosacral angle (LSA), intervertebral foramen height (IFH), and surgical segment. The surgical treatment was evaluated based on the operative time, intraoperative blood loss, and postoperative complications. A correlation analysis and independent sample t-tests were used to assess the relationship between preoperative radiographic variables and surgical treatments. Further, a multivariate linear regression analysis was employed to identify the risk factors affecting the clinical outcomes. Results The correlation analysis and t-test results showed that the MIA, height of the iliac crest, intervertebral facet joint degeneration, and surgical segment were significantly correlated with the surgical treatments (P<0.05). Specifically, the height of the iliac crest, intervertebral facet joint degeneration, and surgical segment were positively correlated with the surgical treatments. Conversely, the MIA was negatively correlated with the surgical treatments. However, no significant differences were observed between the IFH, LSA, and LL in relation to posterior lumbar surgery (P>0.05). The multiple linear regression analysis showed that the height of the iliac crest, MIA, intervertebral facet joint degeneration, and surgical segment were independent factors affecting the surgical treatments of patients with single- or multi-level LDD. These findings highlight the importance of considering these factors when planning and performing lumbar surgery. Conclusions The measurements taken from radiographs, including the height of the iliac crest, MIA, intervertebral facet joint degeneration, and surgical segment, demonstrate potential influences on the treatment of single- and multi-level lumbar spine surgery. These variables can be captured in plain film imaging and can provide valuable insights into the surgical procedure and offer guidance for the operation. By analyzing these radiographic measurements, surgeons can gain a better understanding of a patient's condition and tailor the surgical approach accordingly, thus optimizing the outcomes of the surgery.
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Affiliation(s)
- Xiaowen Liu
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Tianyi Zhao
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chenxi Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Haoyang Shi
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Goedmakers C, Pereboom L, Schoones J, de Leeuw den Bouter M, Remis R, Staring M, Vleggeert-Lankamp C. Machine learning for image analysis in the cervical spine: Systematic review of the available models and methods. BRAIN & SPINE 2022; 2:101666. [PMID: 36506292 PMCID: PMC9729832 DOI: 10.1016/j.bas.2022.101666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/12/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022]
Abstract
•Neural network approaches show the most potential for automated image analysis of thecervical spine.•Fully automatic convolutional neural network (CNN) models are promising Deep Learning methods for segmentation.•In cervical spine analysis, the biomechanical features are most often studied using finiteelement models.•The application of artificial neural networks and support vector machine models looks promising for classification purposes.•This article provides an overview of the methods for research on computer aided imaging diagnostics of the cervical spine.
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Affiliation(s)
- C.M.W. Goedmakers
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands,Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA,Corresponding author. Department of Neurosurgery, Albinusdreef 2, 2300 RC, Leiden, the Netherlands.
| | - L.M. Pereboom
- Faculty of Mechanical, Maritime and Materials Engineering (3mE), Delft University of Technology, Delft, the Netherlands
| | - J.W. Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands
| | - M.L. de Leeuw den Bouter
- Delft Institute of Applied Mathematics, Department of Numerical Analysis, Delft University of Technology, Delft, the Netherlands
| | - R.F. Remis
- Circuits and Systems Group, Microelectronics Department, Delft University of Technology, Delft, the Netherlands
| | - M. Staring
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands,Intelligent Systems Department, Delft University of Technology, Delft, the Netherlands
| | - C.L.A. Vleggeert-Lankamp
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands,Department of Neurosurgery Haaglanden Medical Centre and HAGA Teaching Hospitals, The Hague, the Netherlands,Department of Neurosurgery, Spaarne Gasthuis Haarlem/Hoofddorp, the Netherlands
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Li D, Wang L, Wang Z, Li C, Yuan S, Tian Y, Yu X, Liu X. Age-related radiographic parameters difference between the degenerative lumbar spinal stenosis patients and healthy people and correlation analysis. J Orthop Surg Res 2022; 17:475. [PMID: 36329488 PMCID: PMC9632108 DOI: 10.1186/s13018-022-03374-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To identify age-related radiographic risk factors for degenerative lumbar spinal stenosis (DLSS) and analyze correlations among them. METHODS A total of 180 cases were enrolled in this study, and lumbar magnetic resonance was performed. Among them, 93 cases suffered DLSS and lumbar dynamic X-ray was examined. And following parameters were measured and evaluated: intervertebral disk height (IDH), the ratio of IDH(IDHL4-5/L3-4), initial IDH of L4-5(iIDHL4-5) in the DLSS group, disk degeneration (DD), cartilaginous endplate failure (CEF), Modic changes, the thickness of ligamentum flavum (LF), range of intervertebral motion (ROM), facet joint opening (FJO), facet joint angle (FJA), the standard cross-sectional area (SCSA) of the multifidus, erector spinae, and psoas major muscles. The data of two groups were compared, and the possible risk factors of DLSS were analyzed. RESULTS Compared with the control group, the DLSS group had higher IDH except for L4-5 and larger iIDHL4-5 (P < 0.05). Significant differences were shown in CEF and the thickness of LF at L1-S1 and DD at L4-5 (P < 0.05). The DLSS group had smaller SCSA of multifidus, erector spinae, and psoas major muscles but greater FJA, FJO (P < 0.05). And the risk of DLSS increased when iIDHL4-5 ≥ 10.73 mm, FJA ≥ 52.03° , or FJO ≥ 3.75 mm. IDH positively correlated with SCSA of multifidus and psoas major muscles and ROM at L1-S1 (P < 0.05). DD showed negative linear relations with SCSA of multifidus and psoas muscle and positive linear relation with CEF at L1-2, L2-3, and L5-S1 (P < 0.05). CONCLUSION Larger initial disk height and excessive CEF may induce DLSS by increasing intervertebral mobility to promote DD, and atrophied paravertebral muscles by weakening the stability of lumbar spine.
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Affiliation(s)
- Donglai Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Zheng Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Chao Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Xuguang Yu
- School of Physical Education, Shandong University, Jinan, Shandong, People's Republic of China.
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China.
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Mitchell UH, Johnson AW, Adams L, Sonnefeld T, Owen PJ. Ultrasound imaging measures of vertebral bony landmark distances are weakly to moderately correlated with intervertebral disc height as assessed by MRI. BMJ Open Sport Exerc Med 2022; 8:e001292. [PMID: 35414957 PMCID: PMC8961152 DOI: 10.1136/bmjsem-2021-001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To assess the validity and reliability of ultrasound-derived interbony landmark distances as a proxy for MRI-derived intervertebral disc (IVD) height. Methods This is a cross-sectional criterion validity study. Twelve college-aged participants without current low back pain completed both MRI and ultrasound imaging of the lumbar spine in a prone position. Single-segment and multisegment distances between the spinous and mammillary processes at the lumbar segments (L2/L3, L3/L4, L4/L5) were measured twice using ultrasound and analysed digitally. Sagittal slices of the lumbar spine were taken via T1-weighted MRI and IVD height, and the overall distance between IVDs L2/L3 and L4/L5 was imaged once and measured twice. Results There was moderate correlation between multilevel-based measurements (overall distance between L2 and L5, r=0.677, p=0.016) and the average across three levels (r=0.596, p=0.041) when using the spinous processes as bony landmarks. Single-segment measures were not significantly correlated (all: p>0.092). Accuracy and precision were better for the overall MRI-derived distance between the three IVDs from L2 and L5 MRI and the distance measured between the spinous processes L2–L5. There was excellent reliability within multiple measurements at each location, with intraclass correlation coefficient, ICC(3,1), ranging from 0.93 to 0.99 (95% CI 0.82 to 0.99) for ultrasound and from 0.98 to 0.99 (95% CI 0.92 to 0.99) for MRI. Conclusion Findings do not support the use of ultrasound imaging for estimating single-segment IVD height, yet it may be used to measure the change in distance over time with a certain degree of precision based on its excellent reliability.
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Affiliation(s)
| | - A Wayne Johnson
- Exercises Sciences, Brigham Young University, Provo, Utah, USA
| | - Lauren Adams
- Exercises Sciences, Brigham Young University, Provo, Utah, USA
| | - Tayva Sonnefeld
- Exercises Sciences, Brigham Young University, Provo, Utah, USA
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
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Lippross S, Grages A, Lueders KA, Braunschweig L, Austein F, Tsaknakis K, Lorenz HM, Hell AK. Vertebral body changes after continuous spinal distraction in scoliotic children. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1928-1934. [PMID: 33619647 DOI: 10.1007/s00586-021-06775-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/12/2021] [Accepted: 02/13/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE Growth-friendly spinal implants (GFSI) were established for scoliotic children as an interim solution until definite spinal fusion could be performed during puberty. While deformity control was clearly proven, the effects on vertebral shape and morphology are still unclear. Our prospective study assesses the effect of GFSI with continuous distraction on vertebral body shape and volume in SMA children in comparison with previously untreated age-matched SMA patients. METHODS Cohort I (n = 19, age 13.2 years) were SMA patients without prior surgical scoliosis treatment. Cohort II (n = 24, age 12.4 years) were children, who had continuous spinal distraction with GFSI for 4.5 years. Radiographic measurements and computed tomography (CT) 3D volume rendering were performed before definite spinal fusion. For cohort II, additional radiographs were analyzed before the first surgical implantation of GFSI, after surgery and every year thereafter. RESULTS Our analysis revealed decreased depth and volume in scoliotic patients with prior GFSI compared to scoliotic patients without prior implants. This difference was significant for the lower thoracic and entire lumbar spine. Vertebral body height and pedicle size were unchanged between the two cohorts. CONCLUSION CT data showed volume reduction in the vertebral body in scoliotic children after GFSI treatment. This effect was more severe in the lumbar and lower thoracic area. While vertebral height was identical in both groups, vertebral depth was reduced in the GFSI-treated group. Reduced vertebral depth and altered vertebral morphology should be considered before instrumenting the spine in previously treated scoliotic SMA children. LEVEL OF EVIDENCE III Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Sebastian Lippross
- Department of Trauma, Orthopaedic and Plastic Surgery, Investigations Performed At Pediatric Orthopaedics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.,Department of Orthopaedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Antonia Grages
- Department of Trauma, Orthopaedic and Plastic Surgery, Investigations Performed At Pediatric Orthopaedics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Katja A Lueders
- Department of Trauma, Orthopaedic and Plastic Surgery, Investigations Performed At Pediatric Orthopaedics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Lena Braunschweig
- Department of Trauma, Orthopaedic and Plastic Surgery, Investigations Performed At Pediatric Orthopaedics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Friederike Austein
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Konstantinos Tsaknakis
- Department of Trauma, Orthopaedic and Plastic Surgery, Investigations Performed At Pediatric Orthopaedics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Heiko M Lorenz
- Department of Trauma, Orthopaedic and Plastic Surgery, Investigations Performed At Pediatric Orthopaedics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Anna K Hell
- Department of Trauma, Orthopaedic and Plastic Surgery, Investigations Performed At Pediatric Orthopaedics, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
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Huang J, Shen H, Wu J, Hu X, Zhu Z, Lv X, Liu Y, Wang Y. Spine Explorer: a deep learning based fully automated program for efficient and reliable quantifications of the vertebrae and discs on sagittal lumbar spine MR images. Spine J 2020; 20:590-599. [PMID: 31759132 DOI: 10.1016/j.spinee.2019.11.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although quantitative measurements improve the assessment of disc degeneration, acquirement of quantitative measurements relies on manual segmentation on lumbar magnetic resonance images (MRIs), which may introduce subjective bias. To date, only a few semiautomatic systems have been developed to quantify important components on MRIs. PURPOSE To develop a deep learning based program (Spine Explorer) for automated segmentation and quantification of the vertebrae and intervertebral discs on lumbar spine MRIs. STUDY DESIGN Cross-sectional study. PATIENT SAMPLE The study was extended on the Hangzhou Lumbar Spine Study, a population-based study of mainland Chinese with focuses on lumbar degenerative changes. From this population-based database, 50 sets lumbar MRIs were randomly selected as training dataset, and another 50 as test dataset. OUTCOME MEASURES Regions of vertebrae and discs were manually segmented on T2W sagittal MRIs to train a convolutional neural network for automated segmentation. Intersection-over-union was calculated to evaluate segmentation performance. Computational definitions were proposed to acquire quantitative morphometric and signal measurements for lumbar vertebrae and discs. MRIs in the test dataset were automatically measured with Spine Explorer and manually with ImageJ. METHODS Intraclass correlation coefficient (ICC) were calculated to examine inter-software agreements. Correlations between disc measurements and Pfirrmann score as well as age were examined to assess measurement validity. RESULTS The trained Spine Explorer automatically segments and measures a lumbar MRI in half a second, with mean Intersection-over-union of 94.7% and 92.6% for the vertebra and disc, respectively. For both vertebra and disc measurements acquired with Spine Explorer and ImageJ, the agreements were excellent (ICC=0.81~1.00). Disc measurements significantly correlated to Pfirrmann score, and greater age was associated with greater anterior disc bulging area (r=0.35~0.44) and fewer signal measurements (r=-0.62~-0.77) as automatically acquired with Spine Explorer. CONCLUSIONS Spine Explorer is an efficient, accurate, and reliable tool to acquire comprehensive quantitative measurements for lumbar vertebra and disc. Implication of such deep learning based program can facilitate clinical studies of the lumbar spine.
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Affiliation(s)
- Jiawei Huang
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China
| | - Haotian Shen
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China
| | - Jialong Wu
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China
| | - Xiaojian Hu
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China
| | - Zhiwei Zhu
- Department of Radiology, Dongyang People's Hospital, Dongyang, China
| | - Xiaoqiang Lv
- Department of Orthopedic Surgery, Dongyang People's Hospital, Dongyang, China
| | - Yong Liu
- Department of Control Science, Institute of Cyber-Systems and Control, Zhejiang University, Hangzhou 310027, China.
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, The Second Floor of Building 3, 79# Qingchun Road, Hangzhou 310003, China.
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Lorbergs AL, Allaire BT, Yang L, Kiel DP, Cupples LA, Jarraya M, Guermazi A, Travison TG, Bouxsein ML, Anderson DE, Samelson EJ. A Longitudinal Study of Trunk Muscle Properties and Severity of Thoracic Kyphosis in Women and Men: The Framingham Study. J Gerontol A Biol Sci Med Sci 2019; 74:420-427. [PMID: 29688268 DOI: 10.1093/gerona/gly056] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cross-sectional studies suggest that trunk muscle morphology in the lumbar spine is an important determinant of kyphosis severity in older adults. The contribution of age-related changes in muscle morphology in the thoracic and lumbar spine to progression of kyphosis is not known. Our objective was to determine cross-sectional and longitudinal associations of thoracic and lumbar muscle size and density with kyphosis. METHODS Participants were 1,087 women and men (mean age: 61 years) of the Framingham Heart Study who underwent baseline and follow-up quantitative computed tomography (QCT) scanning 6 years apart. We used QCT scans to measure trunk muscle cross-sectional area (CSA, cm2) and density (HU) at the thoracic and lumbar spine and Cobb angle (degrees) from T4 to T12. Linear regression models estimated the association between muscle morphology and kyphosis. RESULTS At baseline, smaller muscle CSA and lower density of thoracic (but not lumbar) spine muscles were associated with a larger (worse) Cobb angle in women and men. For example, each standard deviation decrease in baseline thoracic paraspinal muscle CSA was associated with a larger baseline Cobb angle in women (3.7 degrees, 95% CI: 2.9, 4.5) and men (2.5 degrees, 95% CI: 1.6, 3.3). Longitudinal analyses showed that loss of muscle CSA and density at the thoracic and lumbar spine was not associated with progression of kyphosis. CONCLUSIONS Our findings suggest that kyphosis severity is related to smaller and lower density trunk muscles at the thoracic spine. Future studies are needed to determine how strengthening mid-back musculature alters muscle properties and contributes to preventing kyphosis progression.
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Affiliation(s)
- Amanda L Lorbergs
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brett T Allaire
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Laiji Yang
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Douglas P Kiel
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - L Adrienne Cupples
- School of Public Health, Boston University, Boston, Massachusetts
- The National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
| | | | - Ali Guermazi
- Quantitative Imaging Center, Boston University School of Medicine, Boston, Massachusetts
| | - Thomas G Travison
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Dennis E Anderson
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth J Samelson
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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