1
|
Din RU, Nishtar T, Cheng X, Yang H. Assessing osteoporosis in postmenopausal women: preliminary results using a novel lumbar spine phantom-based MRI scoring method. LA RADIOLOGIA MEDICA 2024; 129:912-924. [PMID: 38625420 DOI: 10.1007/s11547-024-01814-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE To develop a novel magnetic resonance imaging (MRI) phantom for producing F-score (for fat) and W-score (for water) and to evaluate the performance of these scores in assessing osteoporosis and related vertebral fractures. MATERIALS AND METHODS First, a real-time phantom consisting of oil and water tubes was manufactured. Then, 30 female volunteers (age: 62.3 ± 6.3 years) underwent lumbar spine examination with MRI (using a novel phantom) and dual-energy X-ray absorptiometry (DXA), following ethical approval. MRI phantom-based F-score and W-score were defined by normalizing the vertebral signal intensities (SIs) by the oil and water SIs of the phantom on T1- and T2-weighted images, respectively. The diagnostic performances of the new scores for assessing osteoporosis and vertebral fractures were examined using receiver operating characteristic analysis and compared with DXA-measured areal bone mineral density (DXA-aBMD). RESULTS The F-score and W-score were greater in the osteoporotic patients (3.93 and 2.29) than the non-osteoporotic subjects (3.05 and 1.79) and achieved AUC values of 0.85 and 0.74 (p < 0.05), respectively, when detecting osteoporosis. Similarly, F-score and W-score had greater values for the fracture patients (3.94 and 2.53) than the non-fracture subjects (3.14 and 1.69) and produced better AUC values (0.90 for W-score and 0.79 for F-score) compared to DXA-aBMD (AUC: 0.27, p < 0.05). In addition, the F-score and W-score had a strong correlation (r = 0.77; p < 0.001). CONCLUSION A novel real-time lumber spine MRI phantom was developed, based upon which newly defined F-score and W-score were able to detect osteoporosis and demonstrated an improved ability over DXA-aBMD in differentiating patients with vertebral fractures.
Collapse
Affiliation(s)
- Rahman Ud Din
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing, 100124, China
| | - Tahira Nishtar
- Department of Imaging and Interventional Radiology, Lady Reading Hospital (LRH-MTI), Peshawar, Pakistan
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, National Centre for Orthopaedics, Capital Medical University, Beijing, China
| | - Haisheng Yang
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing, 100124, China.
| |
Collapse
|
2
|
Salamanna F, Faldini C, Veronesi F, Borsari V, Ruffilli A, Manzetti M, Viroli G, Traversari M, Marchese L, Fini M, Giavaresi G. A Pilot Study on Circulating, Cellular, and Tissue Biomarkers in Osteosarcopenic Patients. Int J Mol Sci 2024; 25:5879. [PMID: 38892069 PMCID: PMC11172451 DOI: 10.3390/ijms25115879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Aging comes with the loss of muscle and bone mass, leading to a condition known as osteosarcopenia. Circulating, cellular, and tissue biomarkers research for osteosarcopenia is relatively scarce and, currently, no established biomarkers exist. Here we find that osteosarcopenic patients exhibited elevated basophils and TNFα levels, along with decreased aPPT, PT/INR, IL15, alpha-Klotho, DHEA-S, and FGF-2 expression and distinctive bone and muscle tissue micro-architecture and biomarker expressions. They also displayed an increase in osteoclast precursors with a concomitant imbalance towards spontaneous osteoclastogenesis. Similarities were noted with osteopenic and sarcopenic patients, including a lower neutrophil percentage and altered cytokine expression. A linear discriminant analysis (LDA) on models based on selected biomarkers showed a classification accuracy in the range of 61-78%. Collectively, our data provide compelling evidence for novel biomarkers for osteosarcopenia that may hold potential as diagnostic tools to promote healthy aging.
Collapse
Affiliation(s)
- Francesca Salamanna
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (F.S.); (V.B.); (L.M.); (G.G.)
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (C.F.); (A.R.); (M.M.); (G.V.); (M.T.)
- Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Via Zamboni 33, 40126 Bologna, Italy
| | - Francesca Veronesi
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (F.S.); (V.B.); (L.M.); (G.G.)
| | - Veronica Borsari
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (F.S.); (V.B.); (L.M.); (G.G.)
| | - Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (C.F.); (A.R.); (M.M.); (G.V.); (M.T.)
- Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Via Zamboni 33, 40126 Bologna, Italy
| | - Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (C.F.); (A.R.); (M.M.); (G.V.); (M.T.)
- Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Via Zamboni 33, 40126 Bologna, Italy
| | - Giovanni Viroli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (C.F.); (A.R.); (M.M.); (G.V.); (M.T.)
- Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Via Zamboni 33, 40126 Bologna, Italy
| | - Matteo Traversari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (C.F.); (A.R.); (M.M.); (G.V.); (M.T.)
| | - Laura Marchese
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (F.S.); (V.B.); (L.M.); (G.G.)
| | - Milena Fini
- Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Gianluca Giavaresi
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (F.S.); (V.B.); (L.M.); (G.G.)
| |
Collapse
|
3
|
Pant A, Singh G, Barnwal RP, Sharma T, Singh B. QbD-driven development and characterization of superparamagnetic iron oxide nanoparticles (SPIONS) of a bone-targeting peptide for early detection of osteoporosis. Int J Pharm 2024; 654:123936. [PMID: 38417727 DOI: 10.1016/j.ijpharm.2024.123936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
Osteoporosis is a metabolic disorder that leads to deterioration of bones. The major challenges confronting osteoporosis therapy include early-stage detection and regular disease monitoring. The present studies employed D-aspartic acid octapeptide (-D-Asp-)8 as bone-targeting peptide for evaluating osteoporosis manifestation, and superparamagnetic iron oxide nanoparticles (SPIONs) as nanocarriers for MRI-aided diagnosis. Thermal decomposition technique was employed to synthesize SPIONs, followed by surface-functionalization with hydrophilic ligands. Failure mode effect analysis and factor screening studies were performed to identify concentrations of SPIONs and ligand as critical material attributes, and systematic optimization was subsequently conducted employing face-centered cubic design. The optimum formulation was delineated using desirability function, and design space demarcated with 178.70 nm as hydrodynamic particle size, -24.40 mV as zeta potential, and 99.89 % as hydrophilic iron content as critical quality attributes. XRD patterns ratified lattice structure and SQUID studies corroborated superparamagnetic properties of hydrophilic SPIONs. Bioconjugation of (-D-Asp-)8 with SPIONs (1:1) was confirmed using UV spectroscopy, FTIR and NMR studies. Cell line studies indicated successful targeting of SPIONs to MG-63 human osteoblasts, ratifying enormous bone-targeting and safety potential of peptide-tethered SPIONs as MRI probes. In vivo MRI imaging studies in rats showcased promising contrast ability and safety of peptide-conjugated SPIONs.
Collapse
Affiliation(s)
- Anjali Pant
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India
| | - Gurpal Singh
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India.
| | | | - Teenu Sharma
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab 140 401, India
| | - Bhupinder Singh
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160014, India; Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab 140 401, India.
| |
Collapse
|
4
|
Saad A, Jenko N, Petrou E, Ariyaratne S, Mehta JS, Djearaman MG, Rasul FT, Botchu R. Assessing bone density on MRI: comparison between routine MRI sequences and DEXA scans. 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 2024; 33:1498-1503. [PMID: 38055038 DOI: 10.1007/s00586-023-08021-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/07/2023] [Accepted: 10/22/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Magnetic Resonance Imaging (MRI) is frequently utilised to aid in the comprehensive assessment of back pain, while dual-energy x-ray absorptiometry (DEXA) is the gold standard test for the assessment of bone density. Assessing bone density on MRI could reduce costs and avoid exposing patients to ionising radiation. The aim of this paper is to investigate whether the relative signal intensity of vertebral bodies compared to other structures can detect osteoporosis on MRI. METHODS 100 patients that had undergone both a lumbar spine MRI and a DEXA scan were identified. The T1 and T2 signal intensity of L1-L4 vertebral bodies (VB), cerebro-spinal fluid (CSF), and psoas muscle were measured within a 1-cm2 region of interest (ROI), and the signal intensity ratios were calculated. The ratios were stratified as normal, osteopenic, or osteoporotic based on DEXA T-scores. RESULTS The T1 VB /T1 CSF ratio was significantly higher in the osteoporotic group than the normal and osteopenic groups (p < 0.001). The T1 VB /T1 CSF ratio had excellent discrimination (AUC = 0.841) for the presence of osteoporosis. The Pearson correlation coefficient between the DEXA T-score and the T1 VB/T1 CSF ratio was -0.474 (p < 0.001). The intra-observer (ICC = 0.910, 95% CI = 0.757-0.966) and inter-observer reliability (ICC = 0.927, 95% CI = 0.824-0.970) were excellent. In our cohort, a T1 VB / T1 CSF ratio of greater than 4 is 66.7% sensitive but 90.0% specific for the presence of osteoporosis. CONCLUSION A high T1 VB/T1 CSF ratio suggests osteoporosis on MRI. Prospective validation is needed to confirm these findings.
Collapse
Affiliation(s)
- A Saad
- Spinal Surgery, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - N Jenko
- Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK.
| | - E Petrou
- Radiology, University Hospitals Birmingham NHS Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - S Ariyaratne
- Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - J S Mehta
- Spinal Surgery, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - M G Djearaman
- Radiology, University Hospitals Birmingham NHS Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - F T Rasul
- Neurosurgery, University Hospital, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - R Botchu
- Radiology, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| |
Collapse
|
5
|
Liu D, Kadri A, Hernando D, Binkley N, Anderson PA. MRI-based vertebral bone quality score: relationship with age and reproducibility. Osteoporos Int 2023; 34:2077-2086. [PMID: 37640844 DOI: 10.1007/s00198-023-06893-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
Vertebral bone quality (VBQ) score is an opportunistic measure of bone mineral density using routine preoperative MRI in spine surgery. VBQ score positively correlates with age and is reproducible across serial scans. However, extrinsic factors, including MRI machine and protocol, affect the VBQ score and must be standardized. PURPOSE The purposes of this study were to determine whether VBQ score increased with age and whether VBQ remained consistent across serial MRI studies obtained within 3 months. METHODS This retrospective study evaluated 136 patients, age 20-69, who received two T1-weighted lumbar MRI within 3 months of each other between January 2011 and December 2021. VBQ(L1-4) score was calculated as the quotient of L1-L4 signal intensity (SI) and L3 cerebral spinal fluid (CSF) SI. VBQ(L1) score was calculated as the quotient of L1 SI and L1 CSF SI. Regression analysis was performed to determine correlation of VBQ(L1-4) score with age. Coefficient of variation (CV) was used to determine reproducibility between VBQ(L1-4) scores from serial MRI scans. RESULTS One hundred thirty-six patients (mean ± SD age 44.9 ± 12.5 years; 53.7% female) were included in this study. Extrinsic factors affecting the VBQ score included patient age, MRI relaxation time, and specific MRI machine. When controlling for MRI relaxation/echo time, the VBQ(L1-4) score was positively correlated with age and had excellent reproducibility in serial MRI with CV of 0.169. There was excellent agreement (ICC > 0.9) of VBQ scores derived from the two formulas, VBQ(L1) and VBQ(L1-4). CONCLUSION Extrinsic factors, including MRI technical factors and age, can impact the VBQ(L1-4) score and must be considered when using this tool to estimate bone mineral density (BMD). VBQ(L1-4) score was positively correlated with age. Reproducibility of the VBQ(L1-4) score across serial MRI is excellent especially when controlling for technical factors, supporting use of the VBQ score in estimating BMD. The VBQ(L1) score was a reliable alternative to the VBQ(L1-4) score.
Collapse
Affiliation(s)
- Daniel Liu
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792-3252, USA.
| | - Aamir Kadri
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Diego Hernando
- Department of Radiology and Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Neil Binkley
- Osteoporosis Clinical Research Program, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Paul A Anderson
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792-3252, USA
| |
Collapse
|
6
|
Jain M, Naik S, Mishra NP, Tripathy SK, Neha A, Sahu DP, KP L. Correlation of bone mineral density using the dual energy x-ray absorptiometry and the magnetic resonance imaging of the lumbar spine in Indian patients. J Orthop 2023; 40:65-69. [PMID: 37188144 PMCID: PMC10172620 DOI: 10.1016/j.jor.2023.04.011] [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: 03/01/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
Background Dual-energy x-ray absorptiometry (DEXA) scan is extensively used to diagnose osteoporosis. But surprisingly, osteoporosis remains an underdiagnosed condition with many fragility fracture patients who have failed to undergo DEXA or received concomitant treatment for osteoporosis. Magnetic resonance imaging (MRI) of the lumbar spine is a routine radiological investigation bring done for low back pain. MRI can detect changes in the bone marrow signal intensity on the standard T1-weighted images. This correlation can be explored to measure osteoporosis in elderly and post-menopausal patients. The present study aims to find any correlation of bone mineral density using the DEXA and MRI of the lumbar spine in Indian patients. Methods Five regions of interest (ROI) of size 130-180 mm2 were placed in the vertebral body in the mid-sagittal section and parasagittal sections on either side (four in L1-L4 and one outside body) of elderly patients who underwent MRI for back pain. They also underwent a DEXA scan for osteoporosis. Signal to Noise Ratio (SNR) was calculated by dividing the mean signal intensity obtained for each vertebra by the standard deviation of the noise. Similarly, SNR was measured for 24 controls. An MRI-based "M score" was calculated by getting the difference in SNR patients to SNR controls and then dividing it by the control's standard deviation (SD). Correlation between the T score on DEXA and M scores on MRI was found out. Results With the M score greater than or equal to 2.82, the sensitivity was 87.5%, and the specificity was 76.5%. M scores negatively correlated with the T score. With the increase in the T score, the M score decreased. The Spearman correlation coefficient for the spine T score was -0.651, with a p-value of <0.001, and the hip T score was -0.428, with a p-value of 0.013. Conclusion Our study indicates that MRI investigations are helpful in Osteoporosis assessments. Even though MRI may not replace DEXA, it can give insight into elderly patients who get an MRI routinely for back pain. It may also have a prognostic value.
Collapse
Affiliation(s)
- Mantu Jain
- Department of Orthopedics, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Suprava Naik
- Department of Radiodiagnosis, AIIMS Bhubaneswar, Odisha, 751019, India
| | | | | | - Aishwarya Neha
- Department of Radiodiagnosis, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Dinesh Prasad Sahu
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, Odisha, 751019, India
| | - Lubaib KP
- Department of Orthopedics, AIIMS Bhubaneswar, Odisha, 751019, India
| |
Collapse
|
7
|
Correlation between bone density measurements on CT or MRI versus DEXA scan: A systematic review. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2023; 14:100204. [PMID: 37090222 PMCID: PMC10119682 DOI: 10.1016/j.xnsj.2023.100204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023]
Abstract
Background Novel methods of bone density assessment using computed tomography (CT) and magnetic resonance imaging (MRI) have been increasingly reported in the spine surgery literature. Correlations between these newer measurements and traditional Dual-Energy X-ray Absorptiometry (DEXA) is not well known. The purpose of this study is to perform an updated systematic review of correlations between bone mineral density (BMD) from CT or MRI and DEXA. Methods Articles published between 2011 and 2021 that reported correlations between the CT-HU or MRI measurements to DEXA t-scores or BMD of lumbar spine or hip were included in this systematic review. Results A total of 25 studies (15 CT, 10 MRI) met the inclusion criteria with a total number of 2,745 patients. The pooled correlation coefficient of spine CT-HU versus spine DEXA, spine CT-HU versus hip DEXA and spine CT-HU versus lowest t-score were 0.60, 0.50 and 0.60 respectively. Regarding spine DEXA parameters, the pooled r2 for spine CT-HU versus spine t-score was 0.684 and spine CT-HU versus spine BMD was 0.598. Furthermore, in patients undergoing spine surgery in four studies, the pooled correlation between spine CT and spine DEXA was (r2: 0.64). In MRI studies, the pooled r2 of spine MRI versus spine DEXA and spine MRI versus hip DEXA were -0.41 and -0.44 respectively. Conclusions CT-HU has stronger correlations with DEXA than MRI measurements. Lumbar CT-HU has the highest pooled correlation (r2 = 0.6) with both spine DEXA and lowest skeletal t-score followed by lumbar CT-HU with hip DEXA (r2 = 0.5) and lumbar MRI with hip (r2 = 0.44) and spine (r2 = 0.41) DEXA. Both imaging modalities achieved only a moderate correlation with DEXA. Few studies in both modalities have investigated the correlation in spine surgery populations and the available data shows that the correlations are worse in the degenerative spine population. A careful interruption of CT HU and MRI measurement when evaluation of BMD as they only moderately correlated with DEXA scores. At this time, it is unclear which modality is a better predictor of mechanical complications and clinical outcomes in spine surgery patients.
Collapse
|
8
|
Ruffilli A, Manzetti M, Barile F, Ialuna M, Cerasoli T, Viroli G, Salamanna F, Contartese D, Giavaresi G, Faldini C. Complications after Posterior Lumbar Fusion for Degenerative Disc Disease: Sarcopenia and Osteopenia as Independent Risk Factors for Infection and Proximal Junctional Disease. J Clin Med 2023; 12:jcm12041387. [PMID: 36835924 PMCID: PMC9959484 DOI: 10.3390/jcm12041387] [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: 11/26/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
Proximal Junctional Disease (PJD) and Surgical Site Infection (SSI) are among the most common complications following spine surgery. Their risk factors are not fully understood. Among them, sarcopenia and osteopenia have recently been attracting interest. The aim of this study is to evaluate their influence on mechanical or infective complications after lumbar spine fusion. Patients who underwent open posterior lumbar fusion were analyzed. Through preoperative MRI, central sarcopenia and osteopenia were measured with the Psoas Lumbar Vertebral Index (PLVI) and the M-Score, respectively. Patients were stratified by low vs. high PLVI and M-Score and then by postoperative complications. Multivariate analysis for independent risk factors was performed. A total of 392 patients (mean age 62.6 years, mean follow up 42.4 months) were included. Multivariate linear regression identified comorbidity Index (p = 0.006), and dural tear (p = 0.016) as independent risk factors for SSI, and age (p = 0.014) and diabetes (p = 0.43) for PJD. Low M-score and PLVI were not correlated to a higher complications rate. Age, comorbidity index, diabetes, dural tear and length of stay are independent risk factors for infection and/or proximal junctional disease in patients who undergo lumbar arthrodesis for degenerative disc disease, while central sarcopenia and osteopenia (as measured by PLVI and M-score) are not.
Collapse
Affiliation(s)
- Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesca Barile
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence: ; Tel.: +39-33-8936-5992
| | - Marco Ialuna
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Tosca Cerasoli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giovanni Viroli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesca Salamanna
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Deyanira Contartese
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gianluca Giavaresi
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| |
Collapse
|
9
|
Ruffilli A, Barile F, Cerasoli T, Manzetti M, Viroli G, Ialuna M, Traversari M, Salamanna F, Mazzotti A, Fini M, Faldini C. Sarcopenia and osteopenia are independent risk factors for proximal junctional disease after posterior lumbar fusion: Results of a retrospective study. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:65-70. [PMID: 37213567 PMCID: PMC10198217 DOI: 10.4103/jcvjs.jcvjs_140_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/04/2023] [Indexed: 03/14/2023] Open
Abstract
Study Design This was a retrospective study. Objective Since a better understanding of modifiable risk factors for proximal junctional disease (PJD) may lead to improved postoperative outcomes and less need of revision surgery, the aim of the present study is to determine whether sarcopenia and osteopenia are independent risk factors for PJD in patients undergoing lumbar fusion. Summary of Background Data PJD is one of the most frequent complications following posterior instrumented spinal fusion. It is characterized by a spectrum of pathologies ranging from proximal junctional kyphosis (PJK) to proximal junctional failure (PJF). The etiology of PJD is multifactorial and currently not fully understood. Patient-specific factors, such as age, body mass index, osteoporosis, sarcopenia, and the presence of other comorbidities, can represent potential risk factors. Materials and Methods A retrospective review of patients, aging 50-85 years, who underwent a short (≤3 levels) posterior lumbar fusion for degenerative diseases was performed. Through magnetic resonance imaging (MRI), central sarcopenia and osteopenia were evaluated, measuring the psoas-to-lumbar vertebral index (PLVI) and the M-score. A multivariate analysis was performed to determine the independent risk factors for PJD, PJK, and PJF. Results A total of 308 patients (mean age at surgery 63.8 ± 6.2 years) were included. Ten patients (3.2%) developed a PJD and all required revision surgery. Multivariate regression identified PLVI (P = 0.02) and M-score (P = 0.04) as independent risk factors for both PJK (P = 0.02 and P = 0.04, respectively) and PJF (P = 0.04 and P = 0.01, respectively). Conclusions Sarcopenia and osteopenia, as measured by PLVI and M-score, proved to be independent risk factors for PJD in patients who undergo lumbar fusion for degenerative diseases. Clinical Trial Registration The present study was approved by the Institutional Review Board, CE AVEC 208/2022/OSS/IOR.
Collapse
Affiliation(s)
- Alberto Ruffilli
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Barile
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tosca Cerasoli
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Manzetti
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Viroli
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Ialuna
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Matteo Traversari
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Salamanna
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antonio Mazzotti
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milena Fini
- Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
10
|
Ruffilli A, Manzetti M, Cerasoli T, Barile F, Viroli G, Traversari M, Salamanna F, Fini M, Faldini C. Osteopenia and Sarcopenia as Potential Risk Factors for Surgical Site Infection after Posterior Lumbar Fusion: A Retrospective Study. Microorganisms 2022; 10:1905. [PMID: 36296182 PMCID: PMC9607357 DOI: 10.3390/microorganisms10101905] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 08/27/2023] Open
Abstract
Surgical site infection (SSI) is a feared complication in spinal surgery, that leads to lower outcomes and increased healthcare costs. Among its risk factors, sarcopenia and osteopenia have recently attracted particular interest. The purpose of this article is to evaluate the influence of sarcopenia and osteopenia on the postoperative infection rate in patients treated with posterior fusion for degenerative diseases of the lumbar spine. This retrospective study included data from 308 patients. Charts were reviewed and central sarcopenia and osteopenia were evaluated through magnetic resonance images (MRI), measuring the psoas to lumbar vertebral index (PLVI) and the M score. Multivariate linear regression was performed to identify independent risk factors for infection. The postoperative SSI rate was 8.4%. Patients with low PLVI scores were not more likely to experience postoperative SSI (p = 0.68), while low M-score patients were at higher risk of developing SSI (p = 0.04). However, they did not generally show low PLVI values (p = 0.5) and were homogeneously distributed between low and high PLVI (p = 0.6). Multivariate analysis confirmed a low M score to be an independent risk factor for SSI (p = 0.01). Our results suggest that osteopenia could have significant impact on spinal surgery, and prospective studies are needed to better investigate its role.
Collapse
Affiliation(s)
- Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Tosca Cerasoli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesca Barile
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giovanni Viroli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Matteo Traversari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesca Salamanna
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Milena Fini
- Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| |
Collapse
|
11
|
Kadri A, Binkley N, Hernando D, Anderson PA. Opportunistic Use of Lumbar Magnetic Resonance Imaging for Osteoporosis Screening. Osteoporos Int 2022; 33:861-869. [PMID: 34773484 DOI: 10.1007/s00198-021-06129-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/20/2021] [Indexed: 12/21/2022]
Abstract
UNLABELLED Magnetic resonance imaging (MRI) is a routine assessment before spine surgery. We found that the opportunistic use of MRI with the vertebral bone quality (VBQ) score has good diagnostic ability, with a threshold value of VBQ > 3.0, in recognizing patients who may need further osteoporosis evaluation. INTRODUCTION The purpose of this study was to determine whether the opportunistic use of magnetic resonance imaging (MRI) is useful for identifying spine surgical patients who need further osteoporosis evaluation. METHODS This retrospective study evaluated 83 thoracolumbar spine surgery patients age ≥ 50 who received T1-weighted MRI. Opportunistic MRI was evaluated with the vertebral bone quality (VBQ) score, VBQ (fat) score, and signal-to-noise ratio (SNR). Each uses the median L1-L4 vertebral body signal intensities (SI) divided by either the L3 cerebrospinal fluid (CSF) SI, average SI of the L1 and S1 dorsal fat, or standard deviation (SD) of the background SI dorsal to the skin. Single-level VBQ was calculated as the ratio of the L1 vertebral body and L1 CSF SIs. Receiver-operator curve analysis was performed to determine diagnostic ability. RESULTS The mean age was 70.10, 80% were female, and 96% were Caucasian. The mean ± SD VBQ, single-level VBQ, VBQ (fat), and SNR were 3.39 ± 0.68, 3.56 ± 0.81, 3.95 ± 1.89, and 113.18 ± 77.26, respectively. Using area under the curve, the diagnostic ability of VBQ, single-level VBQ, VBQ (fat), and SNR for clinical osteoporosis were 0.806, 0.779, 0.608, and 0.586, respectively. Diagnostic threshold values identified with optimal sensitivity and specificity were VBQ of 2.95 and single-level VBQ of 3.06. CONCLUSION Opportunistic use of MRI is a simple, effective tool that may help recognize patients who are at risk for complications related to bone disease. A VBQ > 3.0 can identify patients who need additional diagnostic evaluation.
Collapse
Affiliation(s)
- A Kadri
- Department of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine and Public Health, UW Medical Foundation Centennial Building, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA
| | - N Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin, School of Medicine and Public Health, 2870 University Ave, Suite 100, Madison, WI, 53705, USA
| | - D Hernando
- Departments of Radiology and Medical Physics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53705, USA
| | - P A Anderson
- Department of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine and Public Health, UW Medical Foundation Centennial Building, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA.
| |
Collapse
|
12
|
Ehresman J, Schilling A, Yang X, Pennington Z, Ahmed AK, Cottrill E, Lubelski D, Khan M, Moseley KF, Sciubba DM. Vertebral bone quality score predicts fragility fractures independently of bone mineral density. Spine J 2021; 21:20-27. [PMID: 32474223 DOI: 10.1016/j.spinee.2020.05.540] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Current evidence suggests that dual-energy x-ray absorptiometry (DXA) scans, the conventional method defining osteoporosis, is underutilized and, when used, may underestimate patient risk for skeletal fragility. It has recently been suggested that other imaging modalities may better estimate bone quality, such as the magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score which also may assess vertebral compression fracture risk in patients with spine metastases. PURPOSE To evaluate whether VBQ score is predictive of fragility fractures in a population with pre-existing low bone density and at high-risk for fracture. STUDY DESIGN/SETTING Retrospective single-center cohort. PATIENT SAMPLE Patients followed at a metabolic bone clinic for osteopenia and/or osteoporosis. OUTCOME MEASURES Radiographically-documented new-onset fragility fracture. METHODS Patients with a DXA and MRI scans at the time of consultation and ≥2-year follow-up were included. Details were gathered about patient demographics, health history, current medication use, and serological studies of kidney function and bone turnover. For each patient, VBQ score was calculated using T1-weighted lumbar MRI images. Univariable and multivariable analyses were used to identify the independent predictors of a new fragility fracture. To support the construct validity of VBQ, patient VBQ scores were compared to those in a cohort of 45 healthy adults. RESULTS Seventy-two (39.1%) study participants suffered fragility fractures, the occurrence of which was associated with higher VBQ score (3.50 vs. 3.01; p<.001), chronic glucocorticoid use (30.6% vs. 15.2%; p=.014), and a history of prior fragility fracture (36.1% vs. 21.4%; p=.030). Mean VBQ score across all patients in the study cohort was significantly higher than the mean VBQ score in the healthy controls (p<.001). In multivariable analysis, new-onset fracture was independently associated with history of prior fracture (OR=6.94; 95% confidence interval [2.48-19.40]; p<.001), higher VBQ score (OR=2.40 per point; [1.30-4.44]; p=.003), higher body mass index (OR=1.09 per kg/m²; [1.01-1.17]; p=.03), and chronic glucocorticoid use (OR=2.89; [1.03-8.17]; p=0.043). Notably, DXA bone mineral density (BMD) was not found to be significantly predictive of new-onset fractures in the multivariable analysis (p=.081). CONCLUSIONS Here we demonstrate the novel, MRI-derived VBQ score is both an independent predictor of fragility fracture in at-risk patients and a superior predictor of fracture risk than DXA-measured BMD. Given the frequency with which MRIs are obtained by patients undergoing spine surgery consultation, we believe the VBQ score could be a valuable tool for estimating bone quality in order to optimize the management of these patients.
Collapse
Affiliation(s)
- Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA
| | - Andrew Schilling
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA
| | - Xinghai Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA; Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA
| | - Ali Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA
| | - Majid Khan
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Kendall F Moseley
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA.
| |
Collapse
|