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Palanca M, Cavazzoni G, Dall'Ara E. The role of bone metastases on the mechanical competence of human vertebrae. Bone 2023:116814. [PMID: 37257631 DOI: 10.1016/j.bone.2023.116814] [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: 03/15/2023] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 06/02/2023]
Abstract
Spine is the most common site for bone metastases. The evaluation of the mechanical competence and failure location in metastatic vertebrae is a biomechanical and clinical challenge. Little is known about the failure behaviour of vertebrae with metastatic lesions. The aim of this study was to use combined micro-Computed Tomography (microCT) and time-lapsed mechanical testing to reveal the failure location in metastatic vertebrae. Fifteen spine segments, each including a metastatic and a radiologically healthy vertebra, were tested in compression up to failure within a microCT. Volumetric strains were measured using Digital Volume Correlation. The images of undeformed and deformed specimens were overlapped to identify the failure location. Vertebrae with lytic metastases experienced the largest average compressive strains (median ± standard deviation: -8506 ± 4748microstrain), followed by the vertebrae with mixed metastases (-7035 ± 15605microstrain), the radiologically healthy vertebrae (-5743 ± 5697microstrain), and the vertebrae with blastic metastases (-3150 ± 4641microstrain). Strain peaks were localised within and nearby the lytic lesions or around the blastic tissue. Failure between the endplate and the metastasis was identified in vertebrae with lytic metastases, whereas failure localised around the metastasis in vertebrae with blastic lesions. This study showed for the first time the role of metastases on the vertebral internal deformations. While lytic lesions lead to failure of the metastatic vertebra, vertebrae with blastic metastases are more likely to induce failure in the adjacent vertebrae. Nevertheless, every metastatic lesion affects the vertebral deformation differently, making it essential to assess how the lesion affects the bone microstructure. These results suggest that the properties of the lesion (type, size, location within the vertebral body) should be considered when developing clinical tools to predict the risk of fracture in patients with metastatic lesions.
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Affiliation(s)
- Marco Palanca
- Dept of Oncology and Metabolism, The University of Sheffield, Sheffield, UK; INSIGNEO Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK; Dept of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | - Giulia Cavazzoni
- Dept of Oncology and Metabolism, The University of Sheffield, Sheffield, UK; INSIGNEO Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK; Dept of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Enrico Dall'Ara
- Dept of Oncology and Metabolism, The University of Sheffield, Sheffield, UK; INSIGNEO Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
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Wang JN, Xie W, Song DW, Zou J, Yan Q, Feng T, Jin SY, Yang C, Luo ZP, Niu JJ. Recurrence of Local Kyphosis After Percutaneous Kyphoplasty: The Neglected Injury of the Disc-Endplate Complex. Clin Interv Aging 2023; 18:827-834. [PMID: 37229150 PMCID: PMC10202700 DOI: 10.2147/cia.s410992] [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: 03/19/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
Background Recurrent of local kyphosis after percutaneous kyphoplasty (PKP) is rarely reported and discussed. Literatures reported that re-kyphosis is usually a consequence of refractures of augmented or adjacent vertebra. However, whether re-kyphosis should be considered as a complication of refractures and has an impact on clinical efficacy of PKP during follow-up time is unknown. The purpose of this study is to evaluate the related risk factors and clinical significance of the recurrent of local kyphosis in osteoporotic vertebral fracture (OVF) patients without refractures. Patients and Methods A total of 143 patients who underwent single-level PKP were recruited and assigned into the re-kyphosis group and non-re-kyphosis group. Clinical and radiographic data were collected and compared between the two groups. Then, multivariate logistic regression analyses were conducted to identify the related risk factors. Results During follow-up, 16 of the 143 patients presented postoperative re-kyphosis. The average local kyphosis angle increased from 11.81±8.60° postoperatively to 25.13±8.91° at the final follow-up which showed a statistically significant difference (p<0.05). Both groups had significant improvements in postoperative visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores compared to their preoperative values (p<0.05). However, in the re-kyphosis group at final follow-up, the VAS and ODI scores showed worsening compared to the postoperative scores. Logistic regression analysis showed that disc-endplate complex injury (OR=17.46, p=0.003); local kyphosis angle correction (OR=1.84, p<0.001); and vertebral height restoration (OR=1.15, p=0.003) were risk factors for re-kyphosis. Conclusion Re-kyphosis is not rare in patients with osteoporotic vertebral fracture and tends to have an inferior prognosis following PKP surgery. Patients with disc-endplate complex injury and more correction of vertebral height and kyphosis angle are at a higher risk for re-kyphosis after PKP surgery than others.
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Affiliation(s)
- Jin-ning Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Wei Xie
- Department of Orthopaedics, Suzhou Ninth People’s Hospital, Suzhou, Jiangsu, People’s Republic of China
| | - Da-Wei Song
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jun Zou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Qi Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Tao Feng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Sheng-yang Jin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Chao Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Zong-ping Luo
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Orthopedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jun-jie Niu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
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Chen JW, Longo M, Chanbour H, LaBarge ME, Abtahi AM, Stephens BF, Zuckerman SL. Cranially Directed Upper Instrumented Vertebrae Screw Angles Are Associated With Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery. Spine (Phila Pa 1976) 2023; 48:710-719. [PMID: 36728801 DOI: 10.1097/brs.0000000000004573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/10/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To evaluate the impact of the upper instrumented vertebral (UIV) screw angle in adult spinal deformity (ASD) surgery on: (1) proximal junctional kyphosis/failure (PJK/F), (2) mechanical complications and radiographic measurements, and (3) patient-reported outcome measures (PROMs). SUMMARY OF BACKGROUND DATA The effect of UIV screw angle in ASD surgery on patient outcomes remains understudied. MATERIALS AND METHODS A single-institution, retrospective study was undertaken from 2011 to 2017. UIV screw angle was trichotomized into positive: cranially directed screws relative to the superior endplate (2°≤θ), neutral: parallel to the superior endplate (-2°<θ<2°), and negative: caudally directed screws relative to the superior endplate (-2°≥θ). The primary outcome was PJK/F. Secondary outcomes included remaining mechanical complications, reoperation, and PROMs: Oswestry Disability Index, Numeric Rating Scale (NRS) back/leg, and EuroQol. Regression controlled for age, body mass index, postoperative sagittal vertical axis (SVA), and pelvic incidence lumbar-lordosis mismatch. RESULTS Among 145 patients undergoing ASD surgery, UIV screw angles were 35 (24.1%) cranially directed, 24 (16.6%) neutral, and 86 (59.3%) caudally directed. PJK occurred in 47(32.4%) patients. Positive screws were independently associated with increased PJK [odds ratio (OR)=4.88; 95% CI, 1.85-13.5, P =0.002] and PJF (OR=3.06; 95% CI, 1.32-12.30, P =0.015). Among 108 (74.5%) patients with lower thoracic UIV, PJK occurred in 38 (35.1%). Cranially directed screws were independently associated with an increased odds of PJK (OR=5.56; 95% CI, 1.86-17.90, P =0.003) with a threshold of 0.2° (area under the curve =0.65; 95% CI, 0.54-0.76, P <0.001), above which the risk of PJK significantly increased. No association was found between positive screw angle and PJF (OR=3.13; 95% CI, 0.91-11.40, P =0.073). Because of the low number of patients with an upper thoracic UIV (N=37, 25.5%), no meaningful conclusions could be drawn from this subgroup. There was no association between UIV screw angle and remaining mechanical complications, reoperations, postoperative SVA and T1-pelvic angle, or PROMs. CONCLUSIONS Cranially directed UIV screw angles increased the odds of PJK in patients with lower thoracic UIV. Meticulous attention should be paid to the lower thoracic UIV screw angle to mitigate the risk of PJK in ASD.
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Affiliation(s)
- Jeffrey W Chen
- School of Medicine, Vanderbilt University, Nashville, TN
| | - Michael Longo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew E LaBarge
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
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Pei J, Yu A, Geng J, Liu Y, Wang L, Shi J, Zhou F, Zhang T, Huang P, Cheng X. The lumbar spinal endplate lesions grades and association with lumbar disc disorders, and lumbar bone mineral density in a middle-young general Chinese population. BMC Musculoskelet Disord 2023; 24:258. [PMID: 37013527 PMCID: PMC10069090 DOI: 10.1186/s12891-023-06379-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Lumbar vertebral endplates lesions (LEPLs), one of the etiologies of low back pain (LBP), are one of the most prevalent causes of health-care costs. Despite progressively becoming the focus in recent years, almost all studies have concentrated on symptomatic patients rather than general populations. As a result, our study was designed to determine the prevalence and distribution patterns of LEPLs in a middle-young general population, as well as their associations with lumbar disc herniation (LDH), lumbar disc degeneration (LDD), and lumbar vertebral volumetric bone mineral density (vBMD). METHODS Seven hundred fifty-four participants aged 20-60 years were recruited from the subjects enrolled in a 10-year longitudinal study of degeneration of the spine and knee being conducted at the Beijing Jishuitan Hospital and 4 of them were excluded due to the missing of MRIs. In this observational study, a lumbar quantitative computed tomography (QCT) and MRI scan were performed among participants within 48 h. T2-weighted sagittal lumbar MRI images for all included subjects were identified for LEPLs by two independent observers based on morphological and local characteristics. Lumbar vertebral vBMD was measured with QCT. The age, BMI, waistline, hipline, lumbar vBMD, LDD, and LDH were measured to investigate their associations with LEPLs. RESULTS The prevalence of LEPLs was higher among the male subjects. 80% of endplates were recognition as no lesions with a substantial disparity between female (75.6%) and male subjects (83.4%) (p < 0.001). The most common lesions were "wavy/irregular" and "notched", and "fracture" is most involved in L3-4 inferior endplate both in two genders. LEPLs were found to be associated with LDH (≥ 2 levels: OR = 6.859, P < 0.001; 1 level: OR = 2.328, P = 0.002 in men. OR = 5.004, P < 0.001; OR = 1.805, P = 0.014 in women) reference for non-LDH, and hipline in men (OR = 1.123, P < 0.001). CONCLUSIONS LEPLs are the common findings on lumbar MRIs in general population, particularly in men. The presence of these lesions and advance from slightly to severely could be mainly attributed to LDH and men's higher hipline.
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Affiliation(s)
- Jingzhe Pei
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Aihong Yu
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Jian Geng
- Shaanxi University of Chinese Medicine School of Medical Technology, Middle Section of Shiji Avenue, Xixian New District, Xianyang City, Shaanxi Province, China
| | - Yandong Liu
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Jia Shi
- Chinese Center for Disease Control and Prevention, National Institute of Nutrition and Health, 29 Nanwei Road, Xicheng District, Beijing, China
| | - Fengyun Zhou
- Shaanxi University of Chinese Medicine School of Medical Technology, Middle Section of Shiji Avenue, Xixian New District, Xianyang City, Shaanxi Province, China
| | - Tianyu Zhang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Pengju Huang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing, China.
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Li Y, Su Q, Feng X, Li L, Tan J, Ke R. The role of endplate injury in intervertebral disc degeneration after vertebral augmentation in OVCF patients. Front Surg 2023; 9:1091717. [PMID: 36704508 PMCID: PMC9871805 DOI: 10.3389/fsurg.2022.1091717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
Background Whether vertebral augmentation can induce or aggravate the degeneration of adjacent intervertebral discs remains controversial. The purpose of this study is to explore the role of endplate injury in intervertebral disc degeneration after vertebral augmentation. Methods The imaging data of patients with single-segment osteoporotic vertebral compression fractures (OVCFs) were retrospectively analyzed. The upper and lower discs of the fractured vertebrae were defined as cranial and caudal discs, and the discs adjacent to the cranial discs were defined as control discs. According to the integrity of the cranial and caudal endplates, they were divided into an injury group and a noninjury group. At follow-up, the increase in the modified Pfirrmann score on MRI compared with the baseline grade was defined as the occurrence of a degenerative disc change (DDC). The changes in the disc height and the number of DDC cases on MRI during the follow-up in each group were analyzed. Results A total of 56 patients with OVCFs were included in this study, with an average follow-up time of 18.8 ± 14.1 months (3-62 months). In the cranial and caudal discs, the number of DDC cases in the endplate injury group was significantly higher than that in the noninjury group (P = 0.007 and P = 0.018). However, the number of DDC cases in the whole endplate injury group (including the cranial and caudal endplates) was significantly higher than that of the whole noninjury group (P = 0.000) and the control group (P = 0.000). The number of DDC cases in the whole noninjury group was not different from that of the control group (P = 0.192). At follow-up, the disc height of the cranial and caudal endplate injury group was significantly lower than the baseline (P = 0.000 and P = 0.001), but the disc height of the noninjury group was not significantly lower than the baseline (P = 0.074 and P = 0.082). Conclusion Endplate injury is associated with adjacent intervertebral disc degeneration in OVCF patients after vertebral augmentation. Evaluation of endplate damage before vertebral enhancement in OVCF patients has an important reference value for predicting the outcome of adjacent intervertebral discs after surgery.
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Affiliation(s)
- Yongchao Li
- Department of Orthopedics, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China,Department of Orthopedics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qihang Su
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaofei Feng
- Department of Orthopedics, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lijun Li
- Department of Orthopedics, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jun Tan
- Department of Orthopedics, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rongjun Ke
- Department of Orthopedics and Traumatology, Zhenjiang Hospital of Chinese Traditional and Western Medicine, Zhenjiang, China,Correspondence: Rongjun Ke
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Shevroja E, Mo Costabella F, Gonzalez Rodriguez E, Lamy O, Hans D. The fracture predictive ability of lumbar spine BMD and TBS as calculated based on different combinations of the lumbar spine vertebrae. Arch Osteoporos 2022; 17:83. [PMID: 35678937 PMCID: PMC9184435 DOI: 10.1007/s11657-022-01123-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/19/2022] [Indexed: 02/03/2023]
Abstract
Lumbar spine bone mineral density (BMD) and trabecular bone score (TBS) are both calculated on L1-L4 vertebrae. This study investigated the ability to predict osteoporotic fractures of BMD and TBS as calculated based on all possible adjacent L1-L4 vertebrae combinations. Present findings indicate that L1-L3 is an optimal combination to calculate LS-BMD or TBS. INTRODUCTION Lumbar spine (LS) BMD and TBS are both assessed in the LS DXA scans in the same region of interest, L1-L4. We aimed to investigate the ability to predict osteoporotic fractures of all the possible adjacent LS vertebrae combinations used to calculate BMD and TBS and to evaluate if any of these combinations performs better at osteoporotic fracture prediction than the traditional L1-L4 combination. METHODS This study was embedded in OsteoLaus-women cohort in Switzerland. LS-DXA scans were performed using Discovery A System (Hologic). The incident vertebral fractures (VFs) and major osteoporotic fractures (MOFs) were assessed from VF assessments using Genant's method or questionnaires (non-VF MOF). We ran logistic models using TBS and BMD to predict MOF, VF, and non-VF MOF, combining different adjustment factors (age, fracture level, or BMD). RESULTS One thousand six hundred thirty-two women (mean ± SD) 64.4 ± 7.5 years, BMI 25.9 ± 4.5 kg/m2, were followed for 4.4 years and 133 experienced MOF. The association of one SD decrease L1-L3 BMD with the odds ratios (ORs) of MOF was OR 1.32 (95%CI 1.15-1.53), L2-L4 BMD was 1.25 (95%CI 1.09-1.42), and L1-L4 BMD was 1.30 (95%CI 1.14-1.48). One SD decrease in L1-L3 TBS was more strongly associated with the odds of having a MOF (OR 1.64, 95% CI 1.34-2.00), than one SD decrease in L2-L4 TBS (OR 1.48, 95% CI 1.21-1.81), or in L1-L4 TBS (OR 1.60, CI 95% 1.32-1.95). CONCLUSION Current findings indicate that L1-L3 is an optimal combination for the TBS or LS-BMD calculation.
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Affiliation(s)
- Enisa Shevroja
- Interdisciplinary Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - François Mo Costabella
- Interdisciplinary Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Elena Gonzalez Rodriguez
- Interdisciplinary Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Lamy
- Interdisciplinary Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Didier Hans
- Interdisciplinary Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland.
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Yeni YN, Dix MR, Xiao A, Oravec DJ, Flynn MJ. Measuring the thickness of vertebral endplate and shell using digital tomosynthesis. Bone 2022; 157:116341. [PMID: 35092890 PMCID: PMC8858866 DOI: 10.1016/j.bone.2022.116341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/07/2021] [Accepted: 01/23/2022] [Indexed: 02/05/2023]
Abstract
The vertebral endplate and cortical shell play an important structural role and contribute to the overall strength of the vertebral body, are at highest risk of initial failure, and are involved in degenerative disease of the spine. The ability to accurately measure the thickness of these structures is therefore important, even if difficult due to relatively low resolution clinical imaging. We posit that digital tomosynthesis (DTS) may be a suitable imaging modality for measurement of endplate and cortical shell thickness owing to the ability to reconstruct multiplanar images with good spatial resolution at low radiation dose. In this study, for 25 cadaveric L1 vertebrae, average and standard deviation of endplate and cortical shell thickness were measured using images from DTS and microcomputed tomography (μCT). For endplate thickness measurements, significant correlations between DTS and μCT were found for all variables when comparing thicknesses measured in both the overall endplate volume (R2 = 0.25-0.54) and when measurements were limited to a central range of coronal or sagittal slices (R2 = 0.24-0.62). When compared to reference values from the overall shell volume, DTS thickness measurements were generally nonsignificant. However, when measurement of cortical shell thickness was limited to a range of central slices, DTS outcomes were significantly correlated with reference values for both sagittal and coronal central regions (R2 = 0.21-0.49). DTS may therefore offer a means for measurement of endplate thickness and, within a limited sagittal or coronal measurement volume, for measurement of cortical shell thickness.
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Affiliation(s)
- Yener N Yeni
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, United States of America.
| | - Michael R Dix
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, United States of America; School of Medicine, Wayne State University, Detroit, MI, United States of America
| | - Angela Xiao
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, United States of America
| | - Daniel J Oravec
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, United States of America
| | - Michael J Flynn
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, United States of America
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Teraguchi M, Kawakami M, Enyo Y, Kagotani R, Mera Y, Kitayama K, Oka H, Yamamoto Y, Nakagawa M, Nakatani T, Nakagawa Y. Endplate Deficits and Posterior Wall Injury Are Predictive of Prolonged Back Pain after Osteoporotic Vertebral Body Fracture. Spine Surg Relat Res 2022; 6:145-150. [PMID: 35478988 PMCID: PMC8995119 DOI: 10.22603/ssrr.2021-0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/05/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Mamoru Kawakami
- Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital
| | - Yoshio Enyo
- Spine Care Center, Wakayama Medical University Kihoku Hospital
| | - Ryohei Kagotani
- Spine Care Center, Wakayama Medical University Kihoku Hospital
| | - Yoshimasa Mera
- Spine Care Center, Wakayama Medical University Kihoku Hospital
| | - Keita Kitayama
- Spine Care Center, Wakayama Medical University Kihoku Hospital
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo
| | - Yoshio Yamamoto
- Spine Care Center, Wakayama Medical University Kihoku Hospital
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Key BM, Symanski J, Scheidt MJ, Tutton SM. Vertebroplasty, Kyphoplasty, and Implant-Based Mechanical Vertebral Augmentation. Semin Musculoskelet Radiol 2021; 25:785-794. [PMID: 34937118 DOI: 10.1055/s-0041-1739531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Vertebral compression fractures are a global public health issue with a quantifiable negative impact on patient morbidity and mortality. The contemporary approach to the treatment of osteoporotic fragility fractures has moved beyond first-line nonsurgical management. An improved understanding of biomechanical forces, consequential morbidity and mortality, and the drive to reduce opioid use has resulted in multidisciplinary treatment algorithms and significant advances in augmentation techniques. This review will inform musculoskeletal radiologists, interventionalists, and minimally invasive spine surgeons on the proper work-up of patients, imaging features differentiating benign and malignant pathologic fractures, high-risk fracture morphologies, and new mechanical augmentation device options, and it describes the appropriate selection of devices, complications, outcomes, and future trends.
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Affiliation(s)
- Brandon M Key
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John Symanski
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew J Scheidt
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sean M Tutton
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Orthopedic Surgery, and Palliative Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Xue YD, Zhang ZC, Dai WX. Investigation of Preoperative Traction Followed by Percutaneous Kyphoplasty Combined with Percutaneous Cement Discoplasty for the Treatment of Severe Thoracolumbar Osteoporotic Vertebral Compression Fractures. Int J Gen Med 2021; 14:6563-6571. [PMID: 34675623 PMCID: PMC8520486 DOI: 10.2147/ijgm.s333532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/13/2021] [Indexed: 01/15/2023] Open
Abstract
Objective To evaluate the feasibility, clinical efficacy and imaging results of preoperative traction (PT) followed by percutaneous kyphoplasty (PKP) combined with percutaneous cement discoplasty (PCD) for treating severe thoracolumbar osteoporotic vertebral compression fractures (OVCFs). Methods A total of 13 patients with severe thoracolumbar OVCFs treated by PT followed by PKP combined with PCD were enrolled. General information, PT time, operation time, postoperative hospital stay, perioperative complications, visual analog scale (VAS) score, Oswestry disability index (ODI) score, local kyphosis angle, intervertebral angle (IVA), anterior vertebral height (AVH) and posterior vertebral height (PVH) were recorded. Results The average VAS score at admission was 7.4±3.5, decreased to 4.3±1.7 after PT and 2.3±0.7 three days after operation, and 1.5±0.9 at last follow-up. The average ODI score was 73.7±21.4 before operation, decreased to 26.6±9.3 three days after operation and 13.7±7.1 at last follow-up. Compared to VAS and ODI scores at admission, these at the third day after operation and last follow-up were significantly different. At admission, the IVA was 3.4°±6.8°, the disc height was 5.7±1.2mm, the AVH was 10.7±3.2mm, and the PVH was 25.7±4.2 mm, which, after PT, changed to 8.1°±7.3°, 8.6±2.6mm, 18.5±2.8mm, and 26.2±7.1mm, respectively, and the differences were significant. The average kyphotic angle was 43.4°±17.8° at admission, and decreased to 26.3°±6.7° after PT, 17.5°±8.4° three days after operation and 19.1°±10.3° at last follow-up, and the differences were significant. Conclusion PT followed by PKP combined with PCD for the treatment of severe thoracolumbar OVCFs was an effective and simple procedure with satisfactory short-term clinical outcomes by relieving pain and improving kyphosis.
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Affiliation(s)
- You-Di Xue
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou, Jiangsu Province, People's Republic of China
| | - Zhao-Chuan Zhang
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou, Jiangsu Province, People's Republic of China
| | - Wei-Xiang Dai
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou, Jiangsu Province, People's Republic of China
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Yonezawa N, Tokuumi Y, Komine N, Uto T, Toribatake Y, Murakami H, Demura S, Tsuchiya H. Simultaneous-onset infectious spondylitis with vertebral fracture mimicking an acute osteoporotic vertebral fracture erroneously treated with balloon kyphoplasty: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE2135. [PMID: 35855409 PMCID: PMC9265184 DOI: 10.3171/case2135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Early balloon kyphoplasty (BKP) intervention for acute osteoporotic vertebral fracture (OVF) has been reported to be more effective than the conservative treatment. However, complications of early BKP intervention are still unknown. OBSERVATIONS A 71-year-old patient with OVF of L2 underwent BKP 2 weeks after symptom onset. Preoperative magnetic resonance imaging (MRI) and radiograph were compatible with new L2 OVF. Although computed tomography (CT) images revealed the atypical destruction of lower endplate of L2 as OVF, L2 BKP was planned. After BKP, his back pain improved dramatically. Two weeks after BKP, his lower back pain recurred. MRI and CT confirmed the diagnosis of infectious spondylitis with paravertebral abscess formation. With adequate antibiotic treatment and rehabilitation, he was symptom-free and completely ambulatory without signs of infection. LESSONS Signal changes on the fractured vertebral bodies during initial MRI and fractured vertebral instability on radiograph can mislead the surgeon to interpret the infection as a benign compression fracture. If the patients exhibit unusual destruction of the endplate on CT imaging, “simultaneous-onset” spondylitis with vertebral fracture should be included in the differential diagnosis. To determine the strategy for OVF, preoperative biopsy is recommended if simultaneous-onset spondylitis with vertebral fracture is suspected.
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Affiliation(s)
- Noritaka Yonezawa
- Department of Orthopaedic Surgery, Saiseikai Kanazawa Hospital, Kanazawa, Japan
| | - Yuji Tokuumi
- Department of Orthopaedic Surgery, Asanogawa General Hospital, Kanazawa, Japan
| | - Nobuhiko Komine
- Department of Orthopaedic Surgery, Asanogawa General Hospital, Kanazawa, Japan
| | - Takaaki Uto
- Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | | | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Medical School, Nagoya, Japan; and
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Su Q, Li Y, Feng X, Tan J, Ge H, Cheng B, Zhang Y. Association and histological characteristics of endplate injury and intervertebral disc degeneration in a rat model. Injury 2021; 52:2084-2094. [PMID: 34176634 DOI: 10.1016/j.injury.2021.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/08/2021] [Accepted: 05/17/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study was to construct a rat caudal vertebral body fracture model and to analyze the association and histological characteristics of vertebral body fracture with endplate injury and adjacent intervertebral disc degeneration. MATERIALS AND METHODS This study included 144 clean-grade male Sprague-Dawley rats, which were randomly divided into a control, middle vertebral body injury (MI), and endplate injury (EI) groups. A vertebral body fracture with or without endplate injury was developed by either drilling a hole in the middle of a rat caudal vertebral body to create a fracture with an intact endplate or drilling a hole in the vertebral body near the intervertebral disc to create a vertebral body fracture with endplate injury. The histological differences in the adjacent intervertebral discs of vertebral body fractures with or without endplate injury were detected using imaging, non-specific histological staining, immunohistochemistry and TUNEL assay. RESULTS Imaging results revealed that the EI group showed a significant decrease in intervertebral space height and intervertebral disc T2 signal over time. Non-specific histological staining revealed that in the EI group, the intervertebral disc was degenerative. Immunohistochemistry indicated that Aggrecan and Collagen-II were decreased and inflammatory factors were increased in the EI group. The TUNEL detection found that apoptosis was significantly increased in the EI group as compared with the MI and control groups. CONCLUSION In rat caudal vertebral body fractures, a fracture with endplate injury is more likely to induce or accelerate degeneration of adjacent intervertebral discs.
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Affiliation(s)
- Qihang Su
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine. No.301 Yanchang Middle Road, Shanghai 200072, China; Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, China. No. 150 Jimo Road, Shanghai 200120, China
| | - Yongchao Li
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, China. No. 150 Jimo Road, Shanghai 200120, China
| | - Xiaofei Feng
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, China. No. 150 Jimo Road, Shanghai 200120, China
| | - Jun Tan
- Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, China. No. 150 Jimo Road, Shanghai 200120, China
| | - Hengan Ge
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine. No.301 Yanchang Middle Road, Shanghai 200072, China
| | - Biao Cheng
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine. No.301 Yanchang Middle Road, Shanghai 200072, China.
| | - Yan Zhang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital. No.1 North Huanhu West Road, Tianjin 300060, China
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Zhang H, Yang B, Hao D, Wang B, He B, Sun H, Li H, Zhang X. Pain location is associated with fracture type in acute osteoporotic thoracolumbar vertebral fracture: a prospective observation study. PAIN MEDICINE 2021; 23:263-268. [PMID: 34320640 DOI: 10.1093/pm/pnab229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study investigated the relationship between pain location and fracture type in the patients with acute osteoporotic vertebral fracture (OVF). DESIGN A prospective observation study. SUBJECT A total of 306 patients with acute OVF were included. METHODS The site of pain of each patient was recorded, and the patients were divided into pain at fracture site group (group 1) and pain at non-fracture site group (group 2). The fracture type was classified into four types: type I, upper endplate type; type II, central type; type III, lower endplate type; type IV, burst type. RESULTS There were 146 patients in the group 1, of which 20.55% (30/146) were type I, 33.56% (49/146) were type II, 15.75% (23/146) were type III, and 30.14% (44/146) were type IV. There were 227 patients in the group 2, of which 57.27% (130/227) were type I, 5.29% (12/227) were type II, 35.24% (80/227) were type III, and 2.20% (5/227) were type IV. There was a statistical difference in the fracture type distribution between the two groups (P < 0.05). The VAS in the group 1 was higher than that in the group 2 at the initial diagnosis (P < 0.05). CONCLUSIONS For patients with acute OVF, the site of pain is related to the type of fracture. The pain at the fracture site is more often observed in the central type and burst type of fractures, while pain at the non-fracture site is more often observed in the upper and lower endplate type of fractures. Additionally, when OVF are suspected, radiological assessment of thoracic and lumbar spine is recommended to better detect fractures that could cause pain distal to the site of the fracture.
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Affiliation(s)
- Haiping Zhang
- Department of Spine Surgery, Honghui Hospital of Xi'an Jiaotong University Health Science Center
| | - Bo Yang
- Medical College, Yan'an University
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital of Xi'an Jiaotong University Health Science Center
| | - Biao Wang
- Department of Spine Surgery, Honghui Hospital of Xi'an Jiaotong University Health Science Center
| | - Baorong He
- Department of Spine Surgery, Honghui Hospital of Xi'an Jiaotong University Health Science Center
| | - Honghui Sun
- Department of Spine Surgery, Honghui Hospital of Xi'an Jiaotong University Health Science Center
| | - Hui Li
- Department of Spine Surgery, Honghui Hospital of Xi'an Jiaotong University Health Science Center
| | - Xuefang Zhang
- Department of Spine Surgery, Honghui Hospital of Xi'an Jiaotong University Health Science Center
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Zhang S, Wang S, Wang Q, Yang J, Xu S. Image classification of osteoporotic vertebral fracture with endplate-disc complex Injury. BMC Musculoskelet Disord 2021; 22:197. [PMID: 33596887 PMCID: PMC7890829 DOI: 10.1186/s12891-021-04070-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/10/2021] [Indexed: 02/05/2023] Open
Abstract
Background The purpose of this study was to use MRI and CT to observe osteoporosis vertebral fracture (OVF) combined with endplate-disc complex (EDC) injury and to classify the degree of EDC injury according to the changes in EDC signal intensity and morphology on the images. Methods We investigated the incidence of EDC injury, observed the morphology and signal intensity changes of EDC injury using MRI and CT, and graded the injuries from 0 to 4 according to their severity. We compared whether there were differences in the degree of EDC injury among different vertebral fractures, bone mineral density(BMD), and severity of vertebral fractures. Results A total of 479 patients were included in this study, of whom 321 had EDC injury adjacent to the fractured vertebral body. Among those, 158 cases were grade 0, 66 cases were grade 1, 72 cases were grade 2, 78 cases were grade 3, and 92 cases were grade 4. The degree of EDC injury associated with thoracolumbar vertebral fractures was more serious than that of EDC injuries associated with thoracic and lumbar vertebral body fractures. Vertebral fractures with severe osteoporosis were associated with more severe EDC injury. Additionally, the more severe the vertebral fracture, the more severe was the combined EDC injury. Conclusion This study found that the incidence rate of EDC injury reached 67.0%. Among patients with OVF, severe osteoporosis and severe fractures in the thoracolumbar segments were often associated with more severe EDC injury.
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Affiliation(s)
- Shuai Zhang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping S tr eet, Sichuan, 646000, Luzhou City, China
| | - Song Wang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping S tr eet, Sichuan, 646000, Luzhou City, China.
| | - Qing Wang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping S tr eet, Sichuan, 646000, Luzhou City, China
| | - Jin Yang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping S tr eet, Sichuan, 646000, Luzhou City, China
| | - Shuang Xu
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping S tr eet, Sichuan, 646000, Luzhou City, China
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Prost S, Pesenti S, Fuentes S, Tropiano P, Blondel B. Treatment of osteoporotic vertebral fractures. Orthop Traumatol Surg Res 2021; 107:102779. [PMID: 33321233 DOI: 10.1016/j.otsr.2020.102779] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/17/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023]
Abstract
Osteoporosis is a public health problem that is contributing to an increasing number of osteoporotic vertebral fractures. The aim of this lecture is to summarize the current state of knowledge about osteoporotic fractures by answering five questions. 1/How does the spine typically age and how is osteoporosis diagnosed? Various normal aging processes will gradually modify the vertebral column (static, dynamic, bone quality). Osteoporosis is diagnosed through a DEXA scan. 2/How is an osteoporotic fracture evaluated clinically and radiologically? Magnetic resonance imaging is the preferred modality for making the diagnosis and selecting the most appropriate treatment. 3/What are the treatment options for an osteoporotic fracture? The options are conservative treatment, conventional surgery, and minimally invasive techniques (cementoplasty, percutaneous instrumentation). 4/Which fractures should be treated, and which technique should be used? The choice is clear when neurological deficits are present, although the indications are less firm when there is no deficit. The treatment can be conservative (back brace) if the fracture is non-displaced and minimally painful, vertebroplasty if the fracture is painful and shows hyperintensity on T2-STIR sequences, vertebral expansion if the radiological deformity worsens along with symptoms. 5/What are the technical challenges and complications related to the presence of osteoporosis when treating vertebral fractures surgically? The reduced bone stock increases the risk of poor implant hold and postoperative mechanical complications (adjacent fracture, junctional kyphosis). Technical solutions have been developed (augmented screw fixation, transitional zone) to limit their impact. It is essential to know and master these techniques, and their indications. Treatment of the osteoporosis itself is crucial. Level of evidence V; Expert opinion.
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Affiliation(s)
- Solène Prost
- Unité de chirurgie rachidienne, Aix-Marseille université, AP-HM, CNRS, ISM, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Sébastien Pesenti
- Unité de chirurgie rachidienne, Aix-Marseille université, AP-HM, CNRS, ISM, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Stéphane Fuentes
- Unité de chirurgie rachidienne, Aix-Marseille université, AP-HM, CNRS, ISM, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Patrick Tropiano
- Unité de chirurgie rachidienne, Aix-Marseille université, AP-HM, CNRS, ISM, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Benjamin Blondel
- Unité de chirurgie rachidienne, Aix-Marseille université, AP-HM, CNRS, ISM, CHU de Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
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16
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Luo J, Dolan P, Adams MA, Annesley-Williams DJ, Wang Y. A predictive model for creep deformation following vertebral compression fractures. Bone 2020; 141:115595. [PMID: 32814126 DOI: 10.1016/j.bone.2020.115595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023]
Abstract
Many vertebral compression fractures continue to collapse over time, resulting in spinal deformity and chronic back pain. Currently, there is no adequate screening strategy to identify patients at risk of progressive vertebral collapse. This study developed a mathematical model to describe the quantitative relationship between initial bone damage and progressive ("creep") deformation in human vertebrae. The model uses creep rate before damage, and the degree of vertebral bone damage, to predict creep rate of a fractured vertebra following bone damage. Mechanical testing data were obtained from 27 vertebral trabeculae samples, and 38 motion segments, from 26 human spines. These were analysed to evaluate bone damage intensity, and creep rates before and after damage, in order to estimate the model parameter, p, which represents how bone damage affects the change of creep rate after damage. Results of the model showed that p was 1.38 (R2 = 0.72, p < 0.001) for vertebral trabeculae, and 1.48 for motion segments (R2 = 0.22, p = 0.003). These values were not significantly different from each other (P > 0.05). Further analyses revealed that p was not significantly influenced by cortical bone damage, endplate damage, disc degeneration, vertebral size, or vertebral areal bone mineral density (aBMD) (P > 0.05). The key determinant of creep deformation following vertebral compression fracture was the degree of trabecular bone damage. The proposed model could be used to identify the measures of bone damage on routine MR images that are associated with creep deformation so that a screening tool can be developed to predict progressive vertebral collapse following compression fracture.
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Affiliation(s)
- Jin Luo
- School of Biomedical Sciences, University of West London, London W5 5RF, UK.
| | - Patricia Dolan
- Centre for Applied Anatomy, University of Bristol, Bristol BS2 8EJ, UK
| | - Michael A Adams
- Centre for Applied Anatomy, University of Bristol, Bristol BS2 8EJ, UK
| | | | - Yue Wang
- Spine Lab, Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Takegami N, Akeda K, Murata K, Yamada J, Sudo A. Association between non-traumatic vertebral fractures and adjacent discs degeneration: a cross-sectional study and literature review. BMC Musculoskelet Disord 2020; 21:781. [PMID: 33246433 PMCID: PMC7697376 DOI: 10.1186/s12891-020-03814-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022] Open
Abstract
Background Previous clinical studies reported that thoracolumbar vertebral fractures (VFs) associated with high energy spine trauma cause adjacent intervertebral disc (IVD) degeneration; however, the effect of non-traumatic VFs on the progression of adjacent disc degeneration remains to be determined. The purpose of this study was to examine the association between non-traumatic VFs and degenerative changes of adjacent IVDs. Methods Ninety-eight consecutive patients undergoing spinal surgery were included in this study. VFs were semi-quantitatively evaluated by lateral lumbar radiography. Five hundred eighty-eight vertebral bodies (from T12 to L5) and 486 discs (from T12/L1 to L4/L5) were analyzed. The degree of IVD degeneration was evaluated by magnetic resonance imaging (MRI) and classified into two groups according to Pfirrmann’s classification. Grades I, II and III were defined as the early stage of IVD degeneration and Grades IV and V as the advanced stage. Intradiscal vacuum phenomena (VPs) were evaluated by computed tomography. Adjacent IVDs were categorized according to the locations of VFs (superior, inferior, and bilateral). Associations between the presence of VFs and the extent of IVD degeneration or the presence of VPs were statistically analyzed. Results IVDs adjacent to VFs were identified in 115 IVDs (31.1% of total; superior: 11.4%, bilateral: 8.6%, inferior: 11.1%). The presence of VFs was significantly associated with MRI grades of adjacent IVD degeneration (P < 0.01) and the prevalence of VPs within adjacent IVDs (P < 0.01). From logistic regression analysis, age, disc level, and VFs were independent related factors for disc degeneration (P < 0.05). Conclusion This study showed that VFs were an independent related factor for adjacent disc degeneration and occurrence of intradiscal VPs. VFs may affect the micro-environment of adjacent IVDs, leading to disc degeneration and disc rupture.
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Affiliation(s)
- Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Koichiro Murata
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Junichi Yamada
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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18
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Schömig F, Palmowski Y, Nikiforov I, Hartwig T, Pumberger M, Schwabe P, Jacobs C. Burst fractures lead to a fracture-associated intervertebral vacuum phenomenon: a case series of 305 traumatic fractures of the thoracolumbar spine. 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 2020; 30:3068-3073. [PMID: 32910246 DOI: 10.1007/s00586-020-06590-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/23/2020] [Accepted: 08/31/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Intervertebral vacuum phenomenon (IVP) is mainly seen as a sign of degenerative disc diseases. Although studies have shown that IVP also occurs after traumatic injuries to the spine, its clinical relevance in spinal fractures remains unknown. Therefore, the aim of this study was to analyse the prevalence, demographic parameters and fracture morphology in patients with fracture-associated IVP (FAVP) of the thoracolumbar spine. METHODS In this retrospective cohort study, patients with traumatic fractures of the thoracolumbar spine who were admitted between January 2014 and December 2015 were included. CT scans were assessed for the presence of intervertebral areas of gaseous radiolucency, which were defined as IVP. Fractures were classified according to the AOSpine Thoracolumbar Spine Injury Classification System. Demographic and anamnestic data, including age, sex and trauma mechanism, were documented. RESULTS A total of 201 patients with 305 fractures were included. Seventy-three patients with 98 fractures had follow-up CTs. Sixty-eight patients had IVP, of whom 46 patients had FAVP. On the follow-up CT, a significant correlation was found between A3 fractures and FAVP, while initial FAVP was significantly correlated with age and low-velocity trauma mechanisms. Initial degenerative IVP also showed a significant correlation with age. CONCLUSIONS FAVP occurred significantly more often in burst fractures and therefore may lead to disc degeneration due to nutritional supply disturbances via the vertebral endplate. As surgical management strategies for burst fractures are intensively discussed, the appearance of FAVP should be taken in consideration.
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Affiliation(s)
- Friederike Schömig
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Yannick Palmowski
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Igor Nikiforov
- Department for Neurosurgery, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Tony Hartwig
- Department for Trauma and Orthopaedic Surgery, Vivantes Klinikum Spandau, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Philipp Schwabe
- Department for Trauma and Orthopaedic Surgery, Vivantes Klinikum Spandau, Berlin, Germany
| | - Cornelius Jacobs
- Department for Orthopaedics and Trauma Surgery, St. Remigius Krankenhaus Leverkusen, Leverkusen, Germany
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Cain U, Gaetke-Udager K, Siegal D, Yablon CM. Musculoskeletal Injuries in Pregnancy. Semin Roentgenol 2020; 56:79-89. [PMID: 33422186 DOI: 10.1053/j.ro.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Usa Cain
- Musculoskeletal Imaging Fellow, University of Michigan, Ann Arbor, MI
| | | | - Daniel Siegal
- Department of Radiology, Henry Ford Health System, Detroit, MI
| | - Corrie M Yablon
- Department of Radiology, University of Michigan, Ann Arbor, MI
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