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Confavreux CB, Follet H, Mitton D, Pialat JB, Clézardin P. Fracture Risk Evaluation of Bone Metastases: A Burning Issue. Cancers (Basel) 2021; 13:cancers13225711. [PMID: 34830865 PMCID: PMC8616502 DOI: 10.3390/cancers13225711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
Major progress has been achieved to treat cancer patients and survival has improved considerably, even for stage-IV bone metastatic patients. Locomotive health has become a crucial issue for patient autonomy and quality of life. The centerpiece of the reflection lies in the fracture risk evaluation of bone metastasis to guide physician decision regarding physical activity, antiresorptive agent prescription, and local intervention by radiotherapy, surgery, and interventional radiology. A key mandatory step, since bone metastases may be asymptomatic and disseminated throughout the skeleton, is to identify the bone metastasis location by cartography, especially within weight-bearing bones. For every location, the fracture risk evaluation relies on qualitative approaches using imagery and scores such as Mirels and spinal instability neoplastic score (SINS). This approach, however, has important limitations and there is a need to develop new tools for bone metastatic and myeloma fracture risk evaluation. Personalized numerical simulation qCT-based imaging constitutes one of these emerging tools to assess bone tumoral strength and estimate the femoral and vertebral fracture risk. The next generation of numerical simulation and artificial intelligence will take into account multiple loadings to integrate movement and obtain conditions even closer to real-life, in order to guide patient rehabilitation and activity within a personalized-medicine approach.
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Affiliation(s)
- Cyrille B. Confavreux
- Centre Expert des Métastases Osseuses (CEMOS), Département de Rhumatologie, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre Bénite, France
- Université de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (H.F.); (J.B.P.); (P.C.)
- Institut National de la Santé et de la Recherche Médicale INSERM, LYOS UMR1033, 69008 Lyon, France
- Correspondence:
| | - Helene Follet
- Université de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (H.F.); (J.B.P.); (P.C.)
- Institut National de la Santé et de la Recherche Médicale INSERM, LYOS UMR1033, 69008 Lyon, France
| | - David Mitton
- Université de Lyon, Université Gustave Eiffel, Université Claude Bernard Lyon 1, LBMC, UMR_T 9406, 69622 Lyon, France;
| | - Jean Baptiste Pialat
- Université de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (H.F.); (J.B.P.); (P.C.)
- CREATIS, CNRS UMR 5220, INSERM U1294, INSA Lyon, Université Jean Monnet Saint-Etienne, 42000 Saint-Etienne, France
- Service de Radiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre Bénite, France
| | - Philippe Clézardin
- Université de Lyon, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (H.F.); (J.B.P.); (P.C.)
- Institut National de la Santé et de la Recherche Médicale INSERM, LYOS UMR1033, 69008 Lyon, France
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Rezaei A, Tilton M, Li Y, Yaszemski MJ, Lu L. Single-level subject-specific finite element model can predict fracture outcomes in three-level spine segments under different loading rates. Comput Biol Med 2021; 137:104833. [PMID: 34534795 DOI: 10.1016/j.compbiomed.2021.104833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/16/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022]
Abstract
Osteoporosis-related vertebral compression fracture can occur under normal physiological activities. Bone metastasis is another source of vertebral fracture. Different loading rates, either high-energy traumas such as falls or low-energy traumas under normal physiological activities, can result in different fracture outcomes. The aim of the current study was to develop a quantitative computed tomography-based finite element analysis (QCT/FEA) technique for single vertebral bodies to predict fracture strength of three-level spine segments. Developed QCT/FEA technique was also used to characterize vertebral elastic moduli at two loading rates of 5 mm/min, representing a physiologic loading condition, and 12000 mm/min, representing a high-energy trauma. To this end, a cohort of human spine segments divided into three groups of intact, defect, and augmented were mechanically tested to fracture; then, experimental stiffness and fracture strength values were measured. Outcomes of this study showed no significant difference between the elastic modulus equations at the two testing speeds. Areal bone mineral density measured by dual x-ray absorptiometry (DXA/BMD) explained only 53% variability (R2 = 0.53) in fracture strength outcomes. However, QCT/FEA could explain 70% of the variability (R2 = 0.70) in experimentally measured fracture strength values. Adding disk degeneration grading, testing speed, and sex to QCT/FEA-estimated fracture strength values further increased the performance of our statistical model by 14% (adjusted R2 of 0.84 between the prediction and experimental fracture forces). In summary, our results indicated that a single-vertebra model, which is computationally less expensive and more time efficient, is capable of estimating fracture outcomes with acceptable performance (range: 70-84%).
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Affiliation(s)
- Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Maryam Tilton
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Yong Li
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Michael J Yaszemski
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lichun Lu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Rezaei A, Giambini H, Miller Ii AL, Xu H, Xu H, Li Y, Yaszemski MJ, Lu L. CT-based structural analyses of vertebral fractures with polymeric augmentation: A study of cadaveric three-level spine segments. Comput Biol Med 2021; 133:104395. [PMID: 33872967 DOI: 10.1016/j.compbiomed.2021.104395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 12/27/2022]
Abstract
Pathologic vertebral fractures due to metastasis can occur under normal physiologic activities, leading to pain and neurologic deficit. Prophylactic vertebroplasty is a technique used to augment vertebral strength and reduce the risk of fracture. Currently, no technique is available to objectively assess vertebral fracture risk in metastatically-involved vertebral bodies. The aim of the current study was to develop an image-based computational technique to estimate fracture force outcomes during bending. To this end, mechanical testing was performed on intact, simulated defect, PMMA-augmented, and PPF-augmented 3-level spine segments from both sexes under a compression/flexion-type loading condition. The augmentation performance of poly(methyl methacrylate) (PMMA) and poly(propylene fumarate) (PPF) were also evaluated and compared. Cylindrical defects were created in 3-level spine segments with attached posterior elements and ligaments. Using CT images of each segment, a rigidity analysis technique was developed and used for predicting fracture forces during bending. On average, PPF strengthened the segments by about 630 N, resulting in fracture forces similar to those observed in the intact and PMMA-augmented groups. Female spines fractured at about 1150 N smaller force than did male spines. Rigidity analysis, along with age, explained 66% variability in experimental outcomes. This number increased to 74% when vertebral size and age were added to the rigidity analysis as explanatory variables. Both PPF and PMMA similarly increased fracture strength to the level of intact specimens. The results suggest that PPF can be a suitable candidate for augmentation purposes and rigidity analysis can be a promising predicting tool for vertebral fracture forces.
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Affiliation(s)
- Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hugo Giambini
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Alan L Miller Ii
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hao Xu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Haocheng Xu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Yong Li
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Michael J Yaszemski
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Lichun Lu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Prado M, Rezaei A, Giambini H. Density-Dependent Material and Failure Criteria Equations Highly Affect the Accuracy and Precision of QCT/FEA-Based Predictions of Osteoporotic Vertebral Fracture Properties. Ann Biomed Eng 2020; 49:663-672. [PMID: 32820381 DOI: 10.1007/s10439-020-02595-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/11/2020] [Indexed: 11/25/2022]
Abstract
About 700,000 vertebral fractures occur in the US as a result of bone loss. Quantitative computed tomography (QCT)-based finite element analysis (FEA) is a promising tool for fracture risk prediction that is becoming attractive in the clinical setting. The goals of this study were (1) to perform individual and pooled specimen optimization using inverse QCT/FEA modeling to obtain ash density-elastic modulus equations incorporating the whole vertebral body and accounting for all variables used during FE modeling, and (2) to determine the effect of material equations and failure criteria on the accuracy and precision of mechanical properties. Fifty-four (54) human vertebrae were used to optimize material equations based on experimental outcomes and, together with a previously proposed material equation, were implemented in our models using three different failure criteria to obtain fracture loads. Our robust QCT/FEA approach predicted 78% of the failure loads. Material equations resulted in poor accuracy in the predicted stiffness, yet yielded good precision and, more importantly, strong correlations with fracture loads. Both material and fracture criterion equations are equally important in estimating accurate and precise QCT/FEA predictions. Results suggest that both elastic modulus and fracture criterion equations should be validated against experimental outcomes to better explain the response of the tissue under various conditions.
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Affiliation(s)
- Maria Prado
- Department of Biomedical and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, 78249, USA
| | - Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Hugo Giambini
- Department of Biomedical and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, 78249, USA.
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Saldarriaga S, Cataño SJ, Rezaei A, Giambini H. Effect of metastatic lesion size and location on the load-bearing capacity of vertebrae using an optimized ash density-modulus equation. Comput Methods Biomech Biomed Engin 2020; 23:601-610. [PMID: 32310687 DOI: 10.1080/10255842.2020.1754808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
About 1.8 million new cancer cases are estimated in the US in 2019 from which 50-85% might metastasize to the thoracic and lumbar spines. Subject-specific quantitative computed tomography-based finite element analysis (QCT/FEA) is a promising used tool to predict vertebral fracture properties. The aims of this study were twofold: First, to develop an optimized equation for the elastic modulus accounting for all input parameters in FE modeling of fracture properties. Second, to assess the effect of lesion size and location on the predicted fracture loads. An inverse QCT/FEA method was implemented to determine optimal coefficients for the modulus equation as a function of ash density. Lesions of 16 and 20 mm were then virtually located at the center, off-centered, anterior, and posterior regions of the vertebrae. A total of 6426 QCT/FEA models were run to optimize the coefficients and evaluate the effect of lesions on fracture properties. QCT/FEA predicted stiffness showed high correlations (50%) with the experimentally measured values. Compared to a 16 mm lesion size, a 20 mm lesion had a reduction in failure load of 55%, 57%, 52%, and 44% at the center, off-centered, anterior cortex, and pedicle, respectively (p < 0.001). Lesions affecting mostly trabecular bone showed the largest reduction in predicted failure loads (about 55%), and females presented weaker outcomes than males. An optimal elastic modulus equation resulted in accurate vertebral stiffness predictions. A deterioration of the trabecular bone due to the presence of a lesion highly affected the predicted fracture loads, and this reduction was significantly higher in females compared to males.
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Affiliation(s)
- Sebastian Saldarriaga
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Simon Jimenez Cataño
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Hugo Giambini
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
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Cataño Jimenez S, Saldarriaga S, Chaput CD, Giambini H. Dual-energy estimates of volumetric bone mineral densities in the lumbar spine using quantitative computed tomography better correlate with fracture properties when compared to single-energy BMD outcomes. Bone 2020; 130:115100. [PMID: 31678491 DOI: 10.1016/j.bone.2019.115100] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 11/23/2022]
Abstract
It is estimated that over 200 million people worldwide are affected by osteoporosis. Vertebral fracture risk prediction using dual energy x-ray absorptiometry (DXA) is confounded by limitations of the technology, such as 2D measurements of bone mineral density (BMD), inability to measure bone distribution and heterogeneity, and potential overestimations of BMD due to degenerative diseases. To overcome these shortcomings, single energy (SE) quantitative computed tomography (QCT) imaging estimates of Hounsfield units (HU) and volumetric BMD have been implemented as alternative methodologies for assessing fracture risk. However, marrow fat within the vertebrae can highly affect the vBMD and fracture properties estimations. To address this issue, 54 vertebrae were dissected from nine cadaveric spines and scanned using SE-QCT (120kVp) and dual energy (DE)-QCT (80/140 kVp), with the latter accounting for marrow fat within the vertebrae. The vertebrae were then scanned using DXA and subjected to mechanical testing to obtain fracture properties. aBMD outcomes from DXA showed a better correlation with DE-QCT vBMD versus SE outcomes [DE: aBMD vs. vBMD (R2: 0.61); SE: aBMD vs. vBMD (R2: 0.27)]. SE-QCT underestimated vertebral vBMD by -56% (p<0.0001) when compared to DE-QCT. vBMD estimates from SE-QCT could predict 45% and 37% of the vertebral failure loads and stiffness, respectively, compared to 67% and 46% from DE-QCT. DE-QCT vBMD outcomes highly correlated with fracture properties of vertebrae as compared to SE-QCT metrics. As DE scanning has the ability to correct for the effects of bone marrow fat, estimated vBMD from SE-QCT were significantly underestimated compared to DE-QCT. Dual energy CT scanning has the potential to more accurately predict vertebral failure and aid the clinician in the evaluation of appropriate interventions. Future studies should consider implementing DE-QCT in their fracture assessment.
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Affiliation(s)
- Simon Cataño Jimenez
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Sebastian Saldarriaga
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Christopher D Chaput
- Department of Orthopedics, The University of Texas Health Science Center, San Antonio, San Antonio, TX, USA
| | - Hugo Giambini
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA.
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Leone A, Cianfoni A, Zecchi V, Cortese MC, Rumi N, Colosimo C. Instability and impending instability in patients with vertebral metastatic disease. Skeletal Radiol 2019; 48:195-207. [PMID: 30069584 DOI: 10.1007/s00256-018-3032-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/08/2018] [Accepted: 07/16/2018] [Indexed: 02/02/2023]
Abstract
Metastatic disease commonly involves the spine with an increasing incidence due to a worldwide rise of cancer incidence and a longer survival of patients with osseous metastases. Metastases compromise the mechanical integrity of the vertebra and make it susceptible to fracture. Patients with pathological vertebral fracture often become symptomatic, with mechanical pain generally due to intervertebral instability, and may develop spinal cord compression and neurological deficits. Advances in imaging, radiotherapy, as well as in spinal surgery techniques, have allowed the evolution from conventional palliative external beam radiotherapy to modern stereotactic radiosurgery and from traditional open surgery to less-invasive, and sometimes prophylactic stabilization surgical treatments. It is therefore clear that fracture risk prediction, and maintenance or restoration of intervertebral stability, are important objectives in the management of these patients. Correlation between imaging findings and clinical manifestations is crucial, and a common knowledge base for treatment team members rather than a compartmentalized view is very important. This article reviews the literature on the imaging and clinical diagnosis of intervertebral instability and impending instability in the setting of spine metastatic disease, including the spinal instability neoplastic score, which is a reliable tool for diagnosing unstable or potentially unstable metastatic spinal lesions, and on the different elements considered for treatment.
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Affiliation(s)
- Antonio Leone
- Institute of Radiology, Catholic University, School of Medicine, Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy.
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland.,Department of Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Viola Zecchi
- Institute of Radiology, Catholic University, School of Medicine, Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Maria Cristina Cortese
- Institute of Radiology, Catholic University, School of Medicine, Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Nicolò Rumi
- Institute of Radiology, Catholic University, School of Medicine, Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
| | - Cesare Colosimo
- Institute of Radiology, Catholic University, School of Medicine, Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli, 1, 00168, Rome, Italy
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Ogurkowska MB, Błaszczyk A. Variation in human vertebral body strength for vertebral body samples from different locations in segments L1-L5. Clin Biomech (Bristol, Avon) 2018; 60:66-75. [PMID: 30326319 DOI: 10.1016/j.clinbiomech.2018.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 10/03/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The human spine, in particular the lumbar spine, is subject to significant compressive and bending stresses, which affect the structure of the bone tissue of the vertebrae. The more heterogeneous the structure of the spongy bone tissue, the less resistant the whole vertebral body. It is therefore necessary to establish variations in bone strength parameters within one particular vertebral body. METHODS The research material comprised human L1-L5 lumbar vertebrae sampled from 15 donors aged 29-35. A total of 975 samples prepared from the collected material were subjected to compressive and bending strength tests. The samples for the tests were collected from carefully selected locations in order to discover the strength properties of various parts of the vertebral body. FINDINGS In the case of sample 2 (located in the posterior part of the vertebra, at mid-height) the stress values were the lowest and there were statistically significant differences compared to other samples. Moreover the value of compressive force in this case was lower for vertebrae with higher numbers. Top and bottom samples demonstrated statistically significant higher mean values of destructive stress. In terms of the bending strength test, the mean value of destructive stress in all lumbar vertebrae for all samples increased for vertebrae with higher numbers. INTERPRETATION The spongy tissue in healthy vertebral bodies has a very heterogeneous structure. This may be due to the presence of the nutrient canal and the arc structure allowing more springy movement and improved transfer of loads by the vertebral body.
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Affiliation(s)
- M B Ogurkowska
- Department of Biomechanics, Poznan University of Physical Education, Poznan, Poland.
| | - A Błaszczyk
- Department of Biomechanics, Poznan University of Physical Education, Poznan, Poland.
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Alkalay R, Adamson R, Miropolsky A, Hackney D. Female Human Spines with Simulated Osteolytic Defects: CT-based Structural Analysis of Vertebral Body Strength. Radiology 2018; 288:436-444. [PMID: 29869960 DOI: 10.1148/radiol.2018171139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate a CT structural analysis protocol (SAP) for estimating the strength of human female cadaveric spines with lytic lesions. Materials and Methods Osteolytic foci was created in the middle vertebra of 44 thoracic and lumbar three-level segments from 11 female cadavers (age range, 50-70 years). The segments underwent CT by using standard clinical protocol and their failure strength was assessed at CT SAP. The spines were mechanically tested to failure in pure axial compression or in compression with torsion. The relationships of defect size, bone mineral density, and predicted failure load (at CT SAP) with measured vertebral strength were assessed with linear regression. Analysis of variance and Tukey test were used to evaluate the effect of region and mechanical test on spine strength. Results With axial compression, CT SAP predictions of vertebral strength correlated with the thoracic (r = 0.84; P < .001) and lumbar (r = 0.85; P < .001) segment-measured strength. Bone mineral density correlated with the lumbar (r = 0.64; P = .003) and thoracic (r, 0.51; P = .050) strength. At compression with torsion, CT SAP predictions of strength were moderately correlated with vertebral strength (r = 0.66; P = .018). At compression with torsion, bone mineral density was not correlated with spinal strength (thoracic and lumbar: r = 0.31 and r = 0.26, respectively; P = .539 and .610, respectively). The lytic focus size (range, 28%-41%) was not associated with vertebral strength. Conclusion CT SAP assessment of strength in vertebrae with lytic lesions correlated with the measured strength of female vertebral bodies. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Ron Alkalay
- From the Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery (R. Alkalay, R. Adamson, A.M.), and Department of Radiology (D.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Robert Adamson
- From the Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery (R. Alkalay, R. Adamson, A.M.), and Department of Radiology (D.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Alexander Miropolsky
- From the Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery (R. Alkalay, R. Adamson, A.M.), and Department of Radiology (D.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - David Hackney
- From the Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery (R. Alkalay, R. Adamson, A.M.), and Department of Radiology (D.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
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Oppenheimer-Velez ML, Giambini H, Rezaei A, Camp JJ, Khosla S, Lu L. The trabecular effect: A population-based longitudinal study on age and sex differences in bone mineral density and vertebral load bearing capacity. Clin Biomech (Bristol, Avon) 2018; 55:73-78. [PMID: 29698852 PMCID: PMC5987206 DOI: 10.1016/j.clinbiomech.2018.03.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 03/05/2018] [Accepted: 03/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Approximately 16-24% of postmenopausal women are affected by vertebral fractures, negatively affecting their quality of life. Trabecular and cortical bones in vertebrae decline differently with age, thus having a distinct impact on vertebral failure loads. The purpose of this study was to investigate the effect of trabecular and cortical volumetric bone mineral density loss over time on estimated failure loads; and to evaluate the effect of sex and age. METHOD Fracture properties from a cohort of 82 patients were evaluated for L1-L3 vertebrae at baseline and 6th year using an image-based method that implements axial rigidity analysis. Cortical and trabecular volumetric bone mineral density were obtained, as well as their individual contribution to total failure load. Regression analyses were performed to determine the effect of age and sex on volumetric bone mineral density and failure loads. FINDINGS Decline in trabecular and cortical volumetric bone mineral density, and failure load was sex-dependent (p ≤ 0.0095). Cortical and trabecular volumetric bone mineral density reduced 2.08 (g/cm3)/year and 2.02 (g/cm3)/year, respectively. A 1012 N difference in failure load, ~70% attributed to trabecular bone, was found between men and women of similar age. Over 6 years, this difference increased by 287 N. Areal bone mineral density measured by dual X-ray absorptiometry explained ~60% of the vertebral failure load. INTERPRETATION Trabecular bone has a significantly greater effect than cortical bone on the structural integrity and load bearing capacity of vertebrae. This might lead to a higher incidence of fragility fractures in osteoporotic women. Our non-invasive, quantitative computed tomography image-based approach may improve prevention, monitoring, and management of fractures.
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Affiliation(s)
- Marianna L. Oppenheimer-Velez
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, United States,University of Puerto Rico Medical Sciences Campus, School of Medicine, San Juan, Puerto Rico
| | - Hugo Giambini
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Jon J. Camp
- Biomedical Imaging Resource, Mayo Clinic, Rochester, MN, United States
| | - Sundeep Khosla
- Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Lichun Lu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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