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Song K, Zhu W, Zhang Z, Liu B, Zhang M, Tang T, Liang J, Wu W. Synthetic lumbar MRI can aid in diagnosis and treatment strategies based on self-pix networks. Sci Rep 2024; 14:20382. [PMID: 39223186 PMCID: PMC11368963 DOI: 10.1038/s41598-024-71288-4] [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: 01/28/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024] Open
Abstract
CT and MR tools are commonly used to diagnose lumbar fractures (LF). However, numerous limitations have been found in practice. The aims of this study were to innovate and develop a spinal disease-specific neural network and to evaluate whether synthetic MRI of the LF affected clinical diagnosis and treatment strategies. A total of 675 LF patients who met the inclusion and exclusion criteria were included in the study. For each participant, two mid-sagittal CT and T2-weighted MR images were selected; 1350 pairs of LF images were also included. A new Self-pix based on Pix2pix and Self-Attention was constructed. A total of 1350 pairs of CT and MR images, which were randomly divided into a training group (1147 pairs) and a test group (203 pairs), were fed into Pix2pix and Self-pix. The quantitative evaluation included PSNR and SSIM (PSNR1 and SSIM1: real MR images and Pix2pix-generated MR images; PSNR2 and SSIM2: real MR images and Self-pix-generated MR images). The qualitative evaluation, including accurate diagnosis of acute fractures and accurate selection of treatment strategies based on Self-pix-generated MRI, was performed by three spine surgeons. In the LF group, PSNR1 and PSNR2 were 10.884 and 11.021 (p < 0.001), and SSIM1 and SSIM2 were 0.766 and 0.771 (p < 0.001), respectively. In the ROI group, PSNR1 and PSNR2 were 12.350 and 12.670 (p = 0.004), and SSIM1 and SSIM2 were 0.816 and 0.832 (p = 0.005), respectively. According to the qualitative evaluation, Self-pix-generated MRI showed no significant difference from real MRI in identifying acute fractures (p = 0.689), with a good sensitivity of 84.36% and specificity of 96.65%. No difference in treatment strategy was found between the Self-pix-generated MRI group and the real MRI group (p = 0.135). In this study, a disease-specific GAN named Self-pix was developed, which demonstrated better image generation performance compared to traditional GAN. The spine surgeon could accurately diagnose LF and select treatment strategies based on Self-pix-generated T2 MR images.
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Affiliation(s)
- Ke Song
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443000, China
- Yichang Central People's Hospital, Yichang, 443000, China
| | - Wendong Zhu
- College of Computer and Information Technology, China Three Gorges University, Yichang, 430002, China
| | - Zhenxi Zhang
- School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen, 518107, China
| | - Bin Liu
- Wendeng Orthopaedic and Traumatologic Hospital of Shandong Province, Weihai, 264400, China
| | - Meiling Zhang
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443000, China
- Yichang Central People's Hospital, Yichang, 443000, China
| | - Tinglong Tang
- College of Computer and Information Technology, China Three Gorges University, Yichang, 430002, China
| | - Jie Liang
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443000, China
- Yichang Central People's Hospital, Yichang, 443000, China
| | - Weifei Wu
- The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443000, China.
- Yichang Central People's Hospital, Yichang, 443000, China.
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Ono Y, Suzuki N, Sakano R, Kikuchi Y, Kimura T, Sutherland K, Kamishima T. A Deep Learning-Based Model for Classifying Osteoporotic Lumbar Vertebral Fractures on Radiographs: A Retrospective Model Development and Validation Study. J Imaging 2023; 9:187. [PMID: 37754951 PMCID: PMC10532676 DOI: 10.3390/jimaging9090187] [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: 08/24/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Early diagnosis and initiation of treatment for fresh osteoporotic lumbar vertebral fractures (OLVF) are crucial. Magnetic resonance imaging (MRI) is generally performed to differentiate between fresh and old OLVF. However, MRIs can be intolerable for patients with severe back pain. Furthermore, it is difficult to perform in an emergency. MRI should therefore only be performed in appropriately selected patients with a high suspicion of fresh fractures. As radiography is the first-choice imaging examination for the diagnosis of OLVF, improving screening accuracy with radiographs will optimize the decision of whether an MRI is necessary. This study aimed to develop a method to automatically classify lumbar vertebrae (LV) conditions such as normal, old, or fresh OLVF using deep learning methods with radiography. A total of 3481 LV images for training, validation, and testing and 662 LV images for external validation were collected. Visual evaluation by two radiologists determined the ground truth of LV diagnoses. Three convolutional neural networks were ensembled. The accuracy, sensitivity, and specificity were 0.89, 0.83, and 0.92 in the test and 0.84, 0.76, and 0.89 in the external validation, respectively. The results suggest that the proposed method can contribute to the accurate automatic classification of LV conditions on radiography.
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Affiliation(s)
- Yohei Ono
- Department of Radiology, NTT East Medical Center Sapporo, South-1 West-15, Chuo-Ku, Sapporo 060-0061, Japan; (Y.O.); (N.S.)
- Graduate School of Health Sciences, Hokkaido University, North-12 West-5, Kita-Ku, Sapporo 060-0812, Japan
| | - Nobuaki Suzuki
- Department of Radiology, NTT East Medical Center Sapporo, South-1 West-15, Chuo-Ku, Sapporo 060-0061, Japan; (Y.O.); (N.S.)
| | - Ryosuke Sakano
- Department of Radiological Technology, Hokkaido University Hospital, Kita-14 Nishi-5, Kita-Ku, Sapporo 060-8648, Japan;
| | - Yasuka Kikuchi
- Department of Radiology, NTT East Medical Center Sapporo, South-1 West-15, Chuo-Ku, Sapporo 060-0061, Japan; (Y.O.); (N.S.)
- Department of Diagnostic Imaging, Faculty of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo 060-8638, Japan
- Department of Diagnostic and Interventional Radiology, Tonan Hospital, Kita 4 Nishi 7, Chuo-Ku, Sapporo 060-0004, Japan;
| | - Tasuku Kimura
- Department of Radiology, NTT East Medical Center Sapporo, South-1 West-15, Chuo-Ku, Sapporo 060-0061, Japan; (Y.O.); (N.S.)
- Department of Radiology, Hokkaido Medical Center, Yamanote5-7, Nishi-Ku, Sapporo 063-0005, Japan;
| | - Kenneth Sutherland
- Global Center for Biomedical Science and Engineering, Hokkaido University, North-15 West-7, Kita-Ku, Sapporo 060-8638, Japan;
| | - Tamotsu Kamishima
- Faculty of Health Sciences, Hokkaido University, North-12 West-5, Kita-Ku, Sapporo 060-0812, Japan
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Patel N, Jacobs D, John J, Fayed M, Nerusu L, Tandron M, Dailey W, Ayala R, Sibai N, Forrest P, Schwalb J, Aiyer R. Balloon Kyphoplasty vs Vertebroplasty: A Systematic Review of Height Restoration in Osteoporotic Vertebral Compression Fractures. J Pain Res 2022; 15:1233-1245. [PMID: 35509620 PMCID: PMC9058004 DOI: 10.2147/jpr.s344191] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 03/28/2022] [Indexed: 12/20/2022] Open
Abstract
Purpose of Review This systematic review comprehensively compared balloon kyphoplasty and vertebroplasty with respect to height restoration and pain relief. Recent Findings PRISMA guidelines were utilized to compare balloon kyphoplasty and vertebroplasty, focusing on the primary outcome of height restoration and the secondary outcomes of pain relief and functionality. A total of 33 randomized controlled trials were included; 20 reviewed balloon kyphoplasty, 7 reviewed vertebroplasty, and 6 compared vertebroplasty to balloon kyphoplasty. Both treatments restored some vertebral body height and showed benefits in pain reduction and improved patient-reported functionality. Summary Balloon kyphoplasty and vertebroplasty are effective treatments for vertebral compression fractures and this review suggests that balloon kyphoplasty may be favored for vertebral height restoration. Further studies are needed to conclude whether balloon kyphoplasty or vertebroplasty is superior for alleviating pain.
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Affiliation(s)
- Nimesh Patel
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA
- Correspondence: Nimesh Patel, Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA, Tel +1 313-932-5756, Fax +1 313-916-9434, Email
| | - David Jacobs
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Jessin John
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Mohamed Fayed
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Lakshmi Nerusu
- Department of School of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Marissa Tandron
- Department of School of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - William Dailey
- Department of School of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ricardo Ayala
- Department of School of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nabil Sibai
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA
- Department of School of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Patrick Forrest
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA
- Department of School of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jason Schwalb
- Department of School of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurological Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Rohit Aiyer
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, MI, USA
- Department of School of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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Sih IM, Shimokawa N, Zileli M, Fornari M, Parthiban J. Osteoporotic vertebral fractures: radiologic diagnosis, clinical and radiologic factors affecting surgical decision making: WFNS Spine Committee Recommendations. J Neurosurg Sci 2022; 66:291-299. [PMID: 35301843 DOI: 10.23736/s0390-5616.22.05636-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With the varied literature on osteoporotic vertebral fracture that may predispose to diagnostic and management dilemma, it is timely to evaluate and streamline the evidence. The aim of this review is to create recommendations on osteoporotic vertebral fractures regarding radiologic diagnosis, and clinical and radiological factors affecting surgical decision making. A computerized literature search was done using PubMed, Google scholar and Cochrane Database of Systematic Reviews from 2010 to 2020. For radiologic diagnosis, the keywords "osteoporotic vertebral fractures" and "radiologic diagnosis" were used yielding 394 articles (19 relevant articles). For clinical and radiological factors affecting surgical decision making, the keywords "osteoporotic vertebral fractures", "radiologic diagnosis", and "surgery" were used yielding 568 articles (25 relevant articles). All pertinent data were reviewed, and consensus statements were obtained in two virtual separate consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine committee. The statements were voted and yielded positive or negative consensus using the Delphi method. This review summarizes the WFNS Spine Committee recommendations on the radiologic diagnosis, and clinical and radiological factors affecting surgical decision making of osteoporotic vertebral fractures.
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Affiliation(s)
- Ibet M Sih
- Section of Neurosurgery, Institute for the Neurosciences, St. Luke's Medical Center, Bonifacio, Philippines -
| | | | - Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
| | - Maurizio Fornari
- Neurosurgery Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Jutty Parthiban
- Department of Neurosurgery and Spine Unit, Kovai Medical Center and Hospital, Coimbatore, India
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Somma T, DE Rosa A, Mastantuoni C, Esposito F, Meglio V, Romano F, Ricciardi L, DE Divitiis O, DI Somma C. Multidisciplinary management of osteoporotic vertebral fractures. An overview. Minerva Endocrinol (Torino) 2021; 47:189-202. [PMID: 34881854 DOI: 10.23736/s2724-6507.21.03515-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vertebral fractures represent the most frequent complication associated with osteoporosis. Patients harboring a vertebral fracture complain physical impairment including low back pain and spine balance alteration, i.e., kyphosis, leading to subsequent systemic complication, with an increase in morbidity and mortality risk. Different strategies are available in the management of osteoporotic vertebral fractures: medical therapy acts as a prevention strategy while surgical vertebral augmentation procedures, when correctly indicated, aim to reduce pain and to restore the physiological vertebral height. Considering the growing prevalence and incidence of this condition and its socio-economic burden, prevention, diagnosis and treatment of osteoporotic vertebral fractures are of utmost importance. Our aim is to review the current strategies for the management of osteoporotic vertebral fractures providing an integrated multidisciplinary endocrinological, radiological and neurosurgical point of view.
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Affiliation(s)
- Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Andrea DE Rosa
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy -
| | - Ciro Mastantuoni
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Felice Esposito
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Vincenzo Meglio
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Fiammetta Romano
- Unit of Endocrinology, Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
| | - Luca Ricciardi
- Neurosurgery, Department NESMOS, Sapienza University of Rome, Rome, Italy
| | - Oreste DE Divitiis
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Carolina DI Somma
- Unit of Endocrinology, Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
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Survival analysis and risk factors of new vertebral fracture after vertebroplasty for osteoporotic vertebral compression fracture. Spine J 2021; 21:1355-1361. [PMID: 33971326 DOI: 10.1016/j.spinee.2021.04.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/23/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Although risk factors of new adjacent vertebral fracture (AVF) and remote vertebral fracture (RVF) after vertebroplasty may differ, research on this topic is lacking. PURPOSE To determine the natural course of new vertebral fractures after vertebroplasty for osteoporotic vertebral compression fracture (OVCF) and to analyze each risk factor for understanding the incidence of AVF and RVF. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE The study subjects included 205 patients who received vertebroplasty for OVCF and were followed-up for at least 1-year. OUTCOME MEASURES Data on factors that could affect the occurrence of vertebral fractures, such as age, body mass index, and bone density, were collected from the patients' medical records. Fracture pattern, fracture location, sagittal imbalance, degree of segmental kyphosis after vertebroplasty, cement distribution, and cement leakage were radiologically examined. METHODS xDuring the follow-up period, any newly developed vertebral fractures were identified. We analyzed whether the time of occurrence differed between AVF and RVF by performing a survival analysis and each risk factor separately. RESULTS New vertebral fractures occurred in 47 patients (22.9%) after vertebroplasty, AVF occurred in 21 patients (10.2%), and RVF occurred in 26 patients (12.7%). The onset time of AVF was 6.2±1.8 months after vertebroplasty, showing a significant difference from that of RVF, which was 15.2±1.8 months (p<.001). In the univariate analysis, the risk factors of AVF included severe osteoporosis (T-score<-3.0), vertebroplasty in the thoracolumbar junction, sagittal imbalance, and segmental kyphosis angle >15° (p=0.029, p=0.033, p=0.001, and p=0.021, respectively). The risk factors of RVF included severe osteoporosis (T-score <-3.0) and sagittal imbalance (p=0.013 and p=0.004). In the multivariate analysis, the risk factors of AVF included vertebroplasty in the thoracolumbar junction and sagittal imbalance (hazard ratio=3.34, p=0.032 and hazard ratio=4.05, p=0.008), and those of RVF included only sagittal imbalance (hazard ratio=2.66, p=0.024). CONCLUSON After vertebroplasty for OVCF, a significant difference in the meantime of occurrence was found; it took 6 months for AVF and 15 months for RVF to develop. Vertebroplasty in the thoracolumbar junction was identified as a risk factor for AVF, whereas sagittal imbalance was a risk factor of both AVF and RVF.
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Yin H, Wang G, Wang J, Ma Y, Wu M, Qiu S, Su Q. Prevalence and Risk Factor Analysis of Constipation After Thoracolumbar Vertebral Compression Fractures. Int J Gen Med 2021; 14:4117-4123. [PMID: 34354371 PMCID: PMC8331197 DOI: 10.2147/ijgm.s320953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/02/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To analyze the prevalence and risk factors of constipation after thoracolumbar vertebral compression fractures (TVCFs). Methods This retrospective study reviews the records of patients hospitalized between January 1, 2017 and December 31, 2018 with TVCFs. A total of 117 patient’s records are included (n = 117). Univariate and multivariate analysis using the logistic regression method are carried out to identify the prevalence and potential risk factors for constipation after TVCF, including gender, age, number of fractured vertebrae, major segment of vertebral fracture, degree of compression, use of painkillers, diabetes, and the intervention of Zengyechengqi decoction. Results Among the 117 patients with TVCFs that were included in this study, 83 (70.9%) patients developed constipation. Univariate analysis showed that the factors of degree of vertebral compression and the preintervention of Zengyechengqi decoction had statistically significant effects on the incidence of constipation after TVCF (P < 0.05), indicating that they might contribute to the incidence of constipation after TVCF. Multivariate logistic regression analysis showed that degree of vertebral compression was a risk factor (P < 0.05), while preintervention of Zengyechengqi decoction was a protective factor (P < 0.05), for constipation after TVCF. Conclusion Patients with vertebral fractures featuring a higher degree of compression may have a higher risk of constipation. Preintervention of Zengyechengqi decoction can reduce the incidence of constipation after TVCF.
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Affiliation(s)
- Heng Yin
- Department of Orthopedics Wuxi Traditional Chinese Medicine Hospital affiliated to Nanjing University of Chinese Medicine, Wuxi, 214071, People's Republic of China
| | - Gaoxiang Wang
- Nanjing University of Chinese Medicine, Nanjing, 210023, People's Republic of China
| | - Jianwei Wang
- Department of Orthopedics Wuxi Traditional Chinese Medicine Hospital affiliated to Nanjing University of Chinese Medicine, Wuxi, 214071, People's Republic of China
| | - Yong Ma
- Nanjing University of Chinese Medicine, Nanjing, 210023, People's Republic of China
| | - Mao Wu
- Department of Orthopedics Wuxi Traditional Chinese Medicine Hospital affiliated to Nanjing University of Chinese Medicine, Wuxi, 214071, People's Republic of China
| | - Songming Qiu
- Nanjing University of Chinese Medicine, Nanjing, 210023, People's Republic of China
| | - Qiuju Su
- Department of Rehabilitation & Acupuncture, Wuxi People's Hospital Affiliated Nanjing Medical University, Wuxi, 214023, People's Republic of China
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Jin H, Ma X, Liu Y, Yin X, Zhu J, Wang Z, Fan W, Jin Y, Pu J, Zhao J, Liu M, Liu P. Back Pain-Inducing Test, a Novel and Sensitive Screening Test for Painful Osteoporotic Vertebral Fractures: A Prospective Clinical Study. J Bone Miner Res 2020; 35:488-497. [PMID: 31691366 DOI: 10.1002/jbmr.3912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022]
Abstract
To detect painful vertebral fractures (VFs) in back pain populations at risk of osteoporosis, we designed a physical examination test (the Back Pain-Inducing Test [BPIT]) that included three movements: lying supine, rolling over, and sitting up. If back pain is induced during any of these movements, the result is defined as positive, thereby establishing a presumptive diagnosis of painful VFs. Pain severity is quantified using a self-reported numerical rating scale (NRS). The presence or absence of painful VFs is verified by whole-spine magnetic resonance imaging (MRI), the gold standard for final diagnosis. According to the standards for reporting diagnostic accuracy, a real-world, prospective, and observational study was performed on 510 back pain patients (enrolled from a single institute) at risk of osteoporosis. The sensitivity, specificity, and accuracy of the BPIT for identifying painful VFs were 99.1% (95% CI, 97.5% to 99.8%), 67.9% (95% CI, 60.4% to 74.5%), and 89.0%, respectively. The positive and negative predictive values were 86.6% (95% CI, 82.9% to 89.6%) and 97.4% (95% CI, 92.6% to 99.3%), respectively. Cutoff NRS scores for lying supine, rolling over, and sitting up were 3, 0, and 2, respectively. The corresponding area under the receiver operating characteristic curves (AUROCs) of each movement was 0.898 (95% CI, 0.868 to 0.922), 0.884 (95% CI, 0.854 to 0.911), and 0.910 (95% CI, 0.882 to 0.933), respectively. Although the high prevalence of VFs in the enrolled cohort partially limits the external validity of the predictive value in the general population, we conclude that the BPIT is potentially effective for detecting painful VFs in back pain populations at risk of osteoporosis. This test may be used as a stratification tool in decision-making on subsequent imaging procedures: a negative BPIT rules out painful VFs and indicates that an MRI should be spared, whereas a positive BPIT means that an MRI is necessary and is likely to identify painful VFs. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Huaijian Jin
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiaoyuan Ma
- Department of Wound Infection and Drug, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yaoyao Liu
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiang Yin
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Jun Zhu
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Zhong Wang
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Weili Fan
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Yufei Jin
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Jungang Pu
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Jianhua Zhao
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Mingyong Liu
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Peng Liu
- Department of Spine Surgery, Center of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
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