Can paraspinal muscle degeneration be a reason for refractures after percutaneous kyphoplasty? A magnetic resonance imaging observation

Exploring the interplay between paraspinal muscular status and bone health in osteoporosis and fracture risk: a comprehensive literature review on computed tomography (CT) and magnetic resonance imaging (MRI) studies

Background and Objective

Computed tomography (CT) and magnetic resonance imaging (MRI) of the spine are fundamental non-invasive tools to investigate the status of the bone and soft tissue in vivo. A novel and promising approach is to investigate the quality and quantity of paraspinal muscles even beyond the clinical question. The aim of the present review is to summarize current evidence on CT and MRI about the relationship between paraspinal muscular status and bone health in osteoporosis (OP) and fracture risk.

Methods

Literature research was carried out on September 2023 using PubMed, Scopus, and Cochrane databases.

Key Content and Findings

Research investigating the intricate interplay between musculature and bone health reveals that degenerating paraspinal muscles, characterized by shrinking and fatty infiltration, are associated with lower bone mineral density (BMD) and the development of OP. Additionally, research indicates that weaker paraspinal muscles are linked to a higher risk of fractures, including those at the spine.

Conclusions

The findings suggest that paraspinal muscle health may be a significant factor in identifying individuals at risk for OP and fractures. Further investigation is needed to explore the potential of paraspinal muscles in preventing these conditions.

Prediction of subsequent vertebral compression fractures after thoracolumbar kyphoplasty: a multicenter retrospective analysis

OBJECTIVE

Second fractures at the cemented vertebrae (SFCV) are often seen after percutaneous kyphoplasty, especially at the thoracolumbar junction. Our study aimed to develop and validate a preoperative clinical prediction model for predicting SFCV.

METHODS

A cohort of 224 patients with single-level thoracolumbar osteoporotic vertebral fractures (T11-L2) from 3 medical centers was analyzed between January 2017 and June 2020 to derive a preoperative clinical prediction model for SFCV. Backward-stepwise selection was used to select preoperative predictors. We assigned a score to each selected variable and developed the SFCV scoring system. Internal validation and calibration were conducted for the SFCV score.

RESULTS

Among the 224 patients included, 58 had postoperative SFCV (25.9%). The following preoperative measures on multivariable analysis were summarized in the 5-point SFCV score: bone mineral density (≤-3.05), serum 25-hydroxy vitamin D3 (≤17.55 ng/mL), standardized signal intensity of fractured vertebra on T1-weighted images (≤59.52%), C7-S1 sagittal vertical axis (≥3.25 cm), and intravertebral cleft. Internal validation showed a corrected area under the curve of 0.794. A cutoff of ≤1 point was chosen to classify a low risk of SFCV, for which only 6 of 100 patients (6%) had SFCV. A cutoff of ≥4 points was chosen to classify a high risk of SFCV, for which 28 of 41 (68.3%) had SFCV.

CONCLUSION

The SFCV score was found to be a simple preoperative method for identification of patients at low and high risk of postoperative SFCV. This model could be applied to individual patients and aid in the decision-making before percutaneous kyphoplasty.

Correlation between surgical segment mobility and paravertebral muscle fatty infiltration of upper adjacent segment in single-segment LDD patients: retrospective study at a minimum 2 years' follow-up

OBJECTIVE

The purpose of this study was to investigate the relationship between surgical segment mobility and fatty infiltration of the adjacent segment paravertebral muscles in patients with single-segment lumbar degenerative disease (LDD) who underwent decompression with fusion or dynamic stabilization.

METHODS

Retrospective analysis of patients who underwent lumbar decompression combined with titanium rod fixation intertransverse fusion (PITF group), Isobar TTL dynamic stabilization (TTL group) or Isobar EVO dynamic stabilization (EVO group) for single-segment lumbar degenerative disease, from March 2012 to July 2018. The preoperative and final follow-up clinical indexes C-LDSI and the measured imaging indexes (range of motion of the surgical segment and the upper adjacent segment, and Goutallier grade of the upper adjacent segment) were counted, and the differences between the preoperative and final follow-up indexes were compared.

RESULTS

According to the inclusion and exclusion criteria, 68 patients were included in this study, 21 in the PITF group, 24 in the TTL group, and 23 in the EVO group. At the final follow-up, the C-LSDI score had significantly higher in the PITF group than the TTL and EVO groups, and the C-LSDI score was a very strongly negatively correlated with ROM of surgical segment (r=-0.7968, p < 0.001). There was a strong negative correlation between surgical segment and upper adjacent segment mobility (r = -0.6959, p < 0.001). And there was a very strong negative correlation between ROM of surgical segment and upper adjacent segment paravertebral muscle Goutallier classification (r = -0.8092, p < 0.001), whereas the ROM of the upper adjacent segment was strong positive correlated with the Goutallier classification (r = 0.6703, P < 0.001).

CONCLUSION

Compared with decompression combined with rigid fusion, decompression combined with dynamic fixation for single-segment lumbar degenerative disease can significantly reduce postoperative low back stiffness. And a certain range of increased mobility of the dynamic stabilization device can effectively reduce the compensatory mobility of the upper adjacent segment and slow down the fatty infiltration of the paravertebral muscle in the adjacent segment.

Role of paraspinal muscle degeneration in the occurrence and recurrence of osteoporotic vertebral fracture: A meta-analysis

Purpose

Recently, the effects of paraspinal muscle degeneration on osteoporotic vertebral fractures (OVFs) have attracted the attention of researchers; however, studies are limited, and their results vary. Hence, this study aimed to determine the role of paraspinal muscle degeneration in the occurrence and recurrence of OVF.

Methods

Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline, the PubMed, Embase, Web of Science, Wanfang Data, China National Knowledge Infrastructure, and ClinicalTrials.gov databases were comprehensively searched for relevant studies. Studies comparing the cross-sectional area (CSA) or fatty infiltration (FI) of the paraspinal muscles (including the psoas (PS), erector spinae plus multifidus (ES+MF), quadratus lumborum) in patients with and without initial OVF, or with and without recurrent OVF were included and analyzed.

Results

Eleven studies were included in the meta-analysis. Seven studies investigated the effects of paraspinal muscles on initial OVF, and the overall results revealed significantly lower CSAES+MF (SMD: -0.575, 95% CI: -0.866 to -0.285) and CSAPS (SMD: -0.750, 95% CI: -1.274 to -0.226), and higher FI (SMD: 0.768, 95% CI: 0.475 to 1.062) in the fracture group. Meanwhile, four studies evaluated the effects of the paraspinal muscles on recurrent OVF, and the pooled results demonstrated significantly higher FI (SMD:0.720, 95% CI: 0.258 to 1.182) in the refracture group, although no significant difference in CSAES+MF (SMD: -0.103, 95% CI: -0.395 to 0.189) was observed between the two groups.

Conclusions

Paraspinal muscle degeneration plays a role in the occurrence and recurrence of OVF. Assessing the paraspinal muscles may be useful for identifying high-risk populations.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier (CRD42021276681).

Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures, especially in Eastern Asia: a systematic review and meta-analysis

Objective

Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat osteoporotic vertebral compression fractures (OVCF), but the risk of vertebral re-fracture after PVP/PKP remains controversial. This study aims to investigate the incidence and risk factors of vertebral re-fracture after PVP/PKP.

Methods

Relevant literatures published up to November 2021 were collected from PubMed, Embase and Web of Science. A meta-analysis was performed to extract data associated with risk factors of SVCF following the PRISMA guidelines. Also, pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI) was calculated.

Results

A total of 23 studies, encompassing 9372 patients with OVCF, met the inclusion criteria. 1255 patients (13.39%) suffered re-fracture after PVP/PKP surgery. A total of 22 studies were from Eastern Asia and only 1 study was from Europe. Female sex (OR = 1.34, 95%CI 1.09–1.64, P = 0.006), older age (WMD = 2.04, 95%CI 0.84–3.24, P = 0.001), lower bone mineral density (BMD, WMD = − 0.38, 95%CI − 0.49–0.26, P < 0.001) and bone cement leakages (OR = 2.05, 95% CI 1.40–3.00, P < 0.001) increased the risk of SVCF. The results of subgroup analysis showed the occurrence of re-fracture was significantly associated with gender (P = 0.002), age (P = 0.001) and BMD (P < 0.001) in Eastern Asia. Compared with the unfractured group, anterior-to-posterior vertebral body height ratio (AP ratio, WMD = 0.06, 95%CI 0.00–0.12, P = 0.037) and visual analog scale score (VAS, WMD = 0.62, 95%CI 0.09–1.15, P = 0.022) were higher in the refracture group, and kyphotic angle correction ratio (Cobb ratio, WMD = − 0.72, 95%CI − 1.26–0.18, P = 0.008) was smaller in Eastern Asia. In addition, anti-osteoporosis treatment (OR = 0.40, 95% CI 0.27–0.60, P < 0.001) could be a protective factor.

Conclusion

The main factors associated with re-fracture after PVP/PKP are sex, age, bone mineral density, AP ratio, Cobb ratio, VAS score, bone cement leakage and anti-osteoporosis treatment, especially in Eastern Asia.

Efficacy and complications of different surgical modalities of treating osteoporotic spinal compression fracture in the elderly

PURPOSE

To explore the efficacy and complications of different surgical modalities in the treatment of osteoporotic spinal compression fractures (OSCFs) in the elderly.

METHODS

This retrospective study included 98 elderly patients with OSCFs who received surgical treatment in the Changsha Hospital of Traditional Chinese Medicine from March 2018 to July 2020. Based on different surgical treatments, the patients were divided into a percutaneous kyphoplasty (PKP) group (n=51) and a percutaneous vertebroplasty (PVP) group (n=47). The intraoperative blood loss, operation time, the amount of bone cement per vertebral body, length of hospitalization, and fracture healing time were recorded and compared between the two groups. The original anterior wall height and middle height of the compressed fractured vertebra were then evaluated and compared at 3 time points, namely before operation, 2 days after operation, and 6 months after operation. Pain, spinal function improvement and Cobb's angle were evaluated and compared between the two cohorts of patients before operation and 3 months after operation. Adverse reactions and bone cement permeability were recorded and compared between the two groups. Patients' quality of life quality was evaluated using the 36-Item Short-Form Health Survey (SF-36) before treatment and 12 months after treatment. Treatment satisfaction was evaluated.

RESULTS

Intraoperative blood loss, the average use of bone cement per vertebral body and length of hospitalization were similar between the groups (P>0.05). However, the PKP group had significantly longer operation time and fracture healing time than the PVP group (P<0.05). Vertebral 3D volume, as well as anterior wall and middle vertebra heights increased significantly at 6 months after surgery in both groups (all P<0.05). In addition, anterior wall and middle vertebra heights increased more in the PVP group than in the PKP group. The Visual Analogue Scale (VAS) and Oswesrty Disability Index (ODI) scores, as well as Cobb's angle decreased in both groups at 3 months after treatment (all P<0.05). The Cobb's angle and VAS score of the PVP group showed more significant reductions (all P<0.05). The PKP group had a higher incidence of adverse reactions and bone cement leakage rate than the PVP group (all P<0.05). However, no distinct difference was determined between the two groups in terms of patients' quality of life at 12 months after surgery. Treatment satisfaction was significantly higher in the PVP group than the PKP group.

CONCLUSION

For the treatment of senile OSCFs, both PVP and PKP have the advantages of little trauma and quick recovery. PVP has an edge over PKP with significantly shorter operation time, lower possibility of bone cement venous leakage and adjacent cone fracture, and higher surgical safety.

Analysis of Influencing Factors of Medication Compliance in Patients with Recurrent Vertebral Fractures after Percutaneous Kyphoplasty and the Role of Family-Centered Education Intervention

OBJECTIVE

To explore the influencing factors of medication compliance in patients with recurrent vertebral fractures after percutaneous kyphoplasty (PKP) and the role of family-centered education intervention.

METHODS

From January 2018 to January 2021, the general disease-related data survey form and medication compliance questionnaire made by our hospital were used to evaluate the scores of 198 patients with recurrent vertebral fractures after PKP in the Department of Orthopedics of our hospital. Single-factor and multiple linear regression analyses were used to explore the influencing factors of medication compliance in patients with recurring vertebral fractures after PKP. From 198 patients, 80 eligible patients were selected for further research. According to a random number table method, they were divided into the control group (n = 40) given only antiosteoporosis drug treatment and care and the experimental group (n = 40) combined with family-centered education intervention. After 12 months of intervention, the two groups were evaluated for their knowledge of osteoporosis, medication compliance, and physical health.

RESULTS

Of the 198 patients, only 65 had good medication compliance, 90 had poor medication compliance, and 43 were acceptable. Univariate analysis showed that the influencing factors of medication compliance in patients with recurrent vertebral fractures after PKP include the patient's education, living style, per capita monthly income, combined other diseases, number of hospitalizations, and time since the last hospitalization (P < 0.05). Multiple linear regression analysis showed that patients with recurring vertebral fractures after PKP with high education, living with spouse or children, combined with other diseases, frequent hospitalizations, and short time from the last hospitalization had higher medication compliance (P < 0.05). After the intervention, the disease knowledge mastery of the experimental group was significantly better than before and after the intervention in the control group (P < 0.0001). After the intervention, the medication compliance and health status of the experimental group were significantly better than those of the control group (P < 0.05).

CONCLUSION

The medication compliance of patients with recurrent vertebral fractures after PKP is generally poor, and medical staff need to take targeted interventions based on the main factors that affect the patients' medication compliance. Family-centered education intervention is an effective way to improve disease awareness, medication compliance, and health status of patients with recurring vertebral fractures after PKP.