1
|
Wang Y, Zhang J, Tong T, Miao D, Wang F, Wang L. Comparison of Hounsfield Unit, Vertebral Bone Quality, and Dual-Energy X-Ray Absorptiometry T-Score for Predicting Cage Subsidence After Posterior Lumbar Interbody Fusion. Global Spine J 2024:21925682241293038. [PMID: 39397676 DOI: 10.1177/21925682241293038] [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] [Indexed: 10/15/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To compare Hounsfield unit (HU), vertebral bone quality (VBQ), and dual-energy X-ray absorptiometry (DEXA) T-score in predicting cage subsidence (CS) after posterior lumbar interbody fusion. METHODS We retrospectively reviewed patients undergoing PLIF and measured L4 HU and VBQ. Baseline characteristics between CS and non-CS groups were compared. Multiple logistic regression analysis was used to identify risk factors for CS. Receiver operating characteristic (ROC) curves were used to explore the predictive value of variables for CS. Subgroup analysis was conducted for patients with available DEXA results. RESULTS Eighty-four patients were analyzed. The subsidence group was older, with lower L4 HU (92.6 (35.4) vs 130.8 (47.8), P < 0.001) and higher VBQ (3.30 (0.64) vs 2.99 (0.63), P = 0.041) compared to the non-CS group. Low L4 HU (OR 0.979, P = 0.022) was an independent risk factor for subsidence, while VBQ was not. ROC analysis indicated that L4 HU (AUC = 0.733, P < 0.001) exhibited superior predictive performance compared to VBQ (AUC = 0.643, P = 0.032). Subgroup analysis in patients with DEXA showed that the femoral neck T-score (AUC = 0.67, P = 0.037) could differentiate CS, with L4 HU exhibiting the highest predictive ability (AUC = 0.778, P < 0.001), both outperforming VBQ (AUC = 0.645, P = 0.075). CONCLUSIONS Among the three BMD parameters, only low L4 HU could be an independent risk factor for CS. Preoperative HU is mandatory in patients at risk for osteoporosis when undergoing spine surgery.
Collapse
Affiliation(s)
- Yunsheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, China
| | - Jiali Zhang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, China
| | - Tong Tong
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, China
| | - Dechao Miao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, China
| | - Feng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, China
| |
Collapse
|
2
|
Ye W, Wang J, Wang X, Tang P. Comparison of Predictive Performance for Pedicle Screw Loosening Between Computed Tomography-Based Hounsfield Units and Magnetic Resonance Imaging-Based Vertebral Bone Quality Score After Lumbar Surgery. World Neurosurg 2024; 190:e191-e198. [PMID: 39032631 DOI: 10.1016/j.wneu.2024.07.088] [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: 05/19/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To compare predictive performance for pedicle screw loosening between computed tomography (CT)-based Hounsfield units (HU) and magnetic resonance imaging (MRI)-based vertebral bone quality score (VBQ) after lumbar surgery. METHODS A retrospective study was conducted on patients who received transforaminal lumbar interbody fusion continuously at our institution from May 2018 to September 2020. On the basis of 12 months' follow-up lumbar radiographs, screw loosening was defined as a clear zone of minimal thickness of ≥1 mm around the pedicle screw on radiography. VBQ score and HU value were measured using preoperative MRI and CT, respectively. Then, we evaluated the predictive performance of these 2 parameters by comparing the receiver operating characteristic curve. RESULTS In all patients, area under the curve (AUC) of the VBQ score (AUC = 0.752; 95% confidence interval [CI] 0.663-0.841; P < 0.001) was larger than those of the CT HU value (AUC = 0.652; 95% CI 0.558-0.746; P = 0.005), but there was no significant difference between them (PAUC = 0.076). In patients with lumbar spinal stenosis, AUC of VBQ score (AUC = 0.863; 95% CI 0.764-0.961; P < 0.001) was larger than those of the CT HU value (AUC = 0.673; 95% CI 0.513-0.833; P = 0.043), with significant difference (PAUC = 0.003). CONCLUSIONS MRI-based VBQ score and CT-based HU value have similar performance in predicting pedicle screw loosening after lumbar surgery. Furthermore, in patients with lumbar spinal stenosis, VBQ score demonstrated better predictive ability than HU value.
Collapse
Affiliation(s)
- Wu Ye
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiaxing Wang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Orthopedics, Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, China
| | - Xiaokun Wang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Pengyu Tang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| |
Collapse
|
3
|
Hu F, Xue L, Zhao D, Chen C, Jing F, Yang Q. Magnetic Resonance Imaging-Based Vertebral Bone Quality Score for Prediction of Cage Subsidence and Screw Loosening in Patients Undergoing Degenerative Lumbar Surgery: A Meta-analysis. Neurospine 2024; 21:913-924. [PMID: 39363471 PMCID: PMC11456935 DOI: 10.14245/ns.2448496.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/10/2024] [Accepted: 06/18/2024] [Indexed: 10/05/2024] Open
Abstract
OBJECTIVE Poor bone quality is a risk factor for postoperative complications after degenerative lumbar fusion surgery. The magnetic resonance imaging-based vertebral bone quality (VBQ) score is a good tool for assessing bone quality, and this is the first meta-analysis performed to summarize the predictive value of the VBQ score for cage subsidence and screw loosening in patients undergoing degenerative lumbar surgery. METHODS Studies were comprehensively searched in electronic databases. The quality of the studies was assessed. The pooled sensitivity, specificity and summary receiver operating characteristic curve were calculated. Publication bias was assessed and meta-regression was conducted. RESULTS We ultimately included 9 studies with a total of 1,404 patients with a mean age of 60.4 years and a percentage of females of 57.0%. According to the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool to assess methodological quality, the quality of the included studies was relatively low and risks of bias might exist. Results showed that a high VBQ was significantly associated with cage subsidence and screw loosening, and risk factor analysis revealed that the merged odds ratio was 5.37 for cage subsidence and 3.87 for screw loosening. With a VBQ cutoff value of 3.34±0.45, the pooled sensitivity and specificity for the diagnosis of postoperative complications were 0.75 and 0.75, respectively, and the area under the curve was 0.82 (95% confidence interval, 0.78-0.85). CONCLUSION A high VBQ was associated with a high risk of cage subsidence and screw loosening in patients who underwent degenerative lumbar surgery. The VBQ score could be considered for identifying high-risk patients for further evaluation.
Collapse
Affiliation(s)
- Fangke Hu
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Lu Xue
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Dong Zhao
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Chao Chen
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Feng Jing
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| |
Collapse
|
4
|
Pu X, Liu B, Wang D, Xiao W, Liu C, Gu S, Geng C, Li H. Opportunistic use of lumbar computed tomography and magnetic resonance imaging for osteoporosis screening. Osteoporos Int 2024; 35:1625-1631. [PMID: 38942897 DOI: 10.1007/s00198-024-07164-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 06/20/2024] [Indexed: 06/30/2024]
Abstract
Compared with the healthy patients, patients with osteoporosis had a lower Hounsfield unit (HU) value and a higher vertebral bone quality (VBQ) score. Both the HU value and VBQ score can simply distinguish patients with osteoporosis (OP), with a cutoff value of HU value < 97.06 and VBQ score > 3.08. INTRODUCTION The purpose of this study is to determine whether the opportunistic use of computed tomography (CT) or magnetic resonance imaging (MRI) is effective for identifying spine surgical patients with OP. METHODS We retrospectively evaluated 109 lumbar spine surgery patients who received lumbar quantitative CT (QCT) and MRI. Using the area under the curve, the CT-based HU value and MRI-based VBQ score were calculated. Then, based on the QCT results, receiver operating characteristic (ROC) curves were constructed to determine the diagnostic performance of the HU value and VBQ score. RESULTS The HU value was significantly lower in the OP group, and the VBQ score was significantly higher in the OP group. Using the area under the curve, the diagnostic performance of the HU value and VBQ score for OP were 0.959 and 0.880, respectively. The diagnostic threshold values determined with optimal sensitivity and specificity were an HU value of 97.06 and a VBQ score of 3.08. CONCLUSION Opportunistic use of CT and MRI can simply distinguish patients with OP, which are expected to be potential alternatives to T-score for the osteoporosis screening.
Collapse
Affiliation(s)
- Xingxiao Pu
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China
| | - Bailian Liu
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China
| | - Daxing Wang
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China
| | - Weiping Xiao
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China
| | - Chengwei Liu
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China
| | - Shao Gu
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China
| | - Chengkui Geng
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China.
| | - Haifeng Li
- Department of Orthopedics, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, 650051, P. R. China.
| |
Collapse
|
5
|
Hu F, Li X, Zhao D, Chen C, Liu G, Yang Q. The diagnostic value of MRI-based vertebral bone quality score for osteoporosis or osteopenia in patients undergoing lumbar surgery: a meta-analysis. Osteoporos Int 2024:10.1007/s00198-024-07190-6. [PMID: 39085499 DOI: 10.1007/s00198-024-07190-6] [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: 02/08/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024]
Abstract
The importance of osteoporosis assessment before lumbar surgery is well recognized. The MRI-based Vertebral Bone Quality (VBQ) score is introduced to evaluate bone quality; however, its diagnostic value has not been well documented. The purpose of this meta-analysis was to summarize the diagnostic value of the VBQ score for osteoporosis or osteopenia in patients undergoing lumbar surgery. We comprehensively searched electronic databases for studies exploring the diagnostic accuracy of the VBQ score for osteoporosis/osteopenia in patients with lumbar disease following the PRISMA guidelines. The quality of the included studies was assessed. The VBQ scores were compared between the groups, and the pooled sensitivity, specificity, and summary receiver operating characteristic (ROC) were calculated. Publication bias was assessed, and meta-regression was conducted. We included 17 studies with a total of 2815 patients, with a mean age of 66.4 years and a percentage of females of 72.5%. According to the QUADAS-2 tool, the quality of the included studies was relatively high. The results showed a significantly higher VBQ score in the osteoporosis/osteopenia group compared with the control group. According to the mean VBQ cutoff value of 3.02 ± 0.38 for the diagnosis of osteoporosis, the pooled sensitivity and specificity were 0.76 and 0.74, respectively, and the AUC was 0.81. According to the mean VBQ cutoff value of 2.31 ± 0.18 for the diagnosis of osteopenia, the pooled sensitivity and specificity were 0.78 and 0.58, respectively, and the AUC was 0.76. The MRI-based VBQ score could provide useful information for identifying patients with low bone mass who need further evaluation. Future prospective studies are still needed to evaluate the complementary role of the VBQ score.
Collapse
Affiliation(s)
- Fangke Hu
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xiaopeng Li
- Department of Spine Surgery, Weifang People's Hospital, Weifang, Shandong, China
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Dong Zhao
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Chao Chen
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Gang Liu
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China.
| |
Collapse
|
6
|
Din RU, Nishtar T, Cheng X, Yang H. Magnetic resonance imaging phantom-based S1 vertebral scores are indicators of fat-water-like osteoporotic changes in postmenopausal women: a pilot study. Asian Spine J 2024; 18:560-569. [PMID: 39165061 PMCID: PMC11366554 DOI: 10.31616/asj.2024.0116] [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: 03/25/2024] [Revised: 05/17/2024] [Accepted: 06/04/2024] [Indexed: 08/23/2024] Open
Abstract
STUDY DESIGN A prospective study. PURPOSE To assess fat-water-like tissue changes on the 1st sacral vertebra using novel magnetic resonance imaging (MRI) phantombased F- and W-scores and evaluate their diagnostic performances in osteoporosis detection. OVERVIEW OF LITERATURE Using an uncommonly advanced MRI technique, previous studies have found that fat-water changes were consistent with osteoporosis. The role of routine MRI sequences can be extended in this regard. The S1 vertebra is considered a crucial anatomical site in spine surgeries because it seldom suffers from fractures. Thus, S1 could indicate osteoporotic fat-water changes. METHODS Forty-two female volunteers (aged 62.3±6.3 years) underwent spine examination with both MRI (including a phantom) and dual-energy X-ray absorptiometry (DXA) following ethical approval. MRI phantom-based F- and W-scoreS1 were defined by normalizing S1 vertebral signal intensities (SIs) by coconut oil and water SIs of the phantom on T1- and T2-weighted imaging, respectively. Using receiver operating characteristic analysis, the diagnostic performances of the new scores for evaluating osteoporosis and vertebral fractures were investigated against standard areal bone mineral density measured with DXA (DXA-aBMD). RESULTS The F-scoreS1 and W-scoreS1 were greater (4.11 and 2.43, respectively) in patients with osteoporosis than those without osteoporosis (3.25 and 1.92, respectively) and achieved areas under the curve (AUCs) of 0.82 and 0.76 (p<0.05), respectively, for osteoporosis detection. Similarly, the mean F-scoreS1 and W-scoreS1 were higher (4.11 and 2.63, respectively) in patients with vertebral fractures than in those without fractures (3.30 and 1.82, respectively) and had greater AUCs (0.90 for W-scoreS1 and 0.74 for F-scoreS1) than DXA-aBMD (AUC, 0.26; p<0.03). In addition, the F- and W-scoreS1 demonstrated a strong correlation (r=0.65, p<0.001). CONCLUSIONS The new S1 vertebral-based MRI scores were developed to detect osteoporotic changes and demonstrated improvements 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, Beijing,
China
| | - Tahira Nishtar
- Department of Imaging and Interventional Radiology, Lady Reading Hospital (LRH-MTI), Peshawar,
Pakistan
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing,
China
| | - Haisheng Yang
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing,
China
| |
Collapse
|
7
|
Menta AK, Weber-Levine C, Jiang K, Hersh AM, Davidar AD, Bhimreddy M, Ashayeri K, Sacino A, Chang L, Lubelski D, Theodore N. Robotic assisted surgery for the treatment of spinal metastases: A case series. Clin Neurol Neurosurg 2024; 243:108393. [PMID: 38917745 DOI: 10.1016/j.clineuro.2024.108393] [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: 03/30/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVE Spinal metastases can significantly affect quality of life in patients with cancer and present complex neurosurgical challenges for surgeons. Surgery with instrumentation is often indicated to alleviate pain, preserve neurological function, and ensure mechanical stability. However, distortions in the bony anatomy due to oncological disease can decrease the accuracy of pedicle screw placement. Robotic-assisted surgery may offer an opportunity to increase screw accuracy and improve navigation of spinal lesions compared to conventional techniques. Therefore, we presented our institutional experience evaluating robotic-assisted surgical fixation for spinal metastases. METHODS Patients undergoing robotic-assisted surgery at a large tertiary care center between January 2019 - January 2023 for the treatment of spinal metastases were identified. Patient characteristics, including demographics, tumor pathology, surgical complications, and post-operative outcomes were extracted. The Gertzbein Robbins classification system (GRS) was used to assess pedicle screw placement accuracy in patients with post-operative computed tomography. RESULTS Twenty patients were identified, including 7 females (35 %), with an overall median age of 66 years (range: 39-80 years) and median BMI of 25 kg/m2 (range: 17-34 kg/m2). An average of four spinal levels were instrumented, with metastases located primarily in the thoracic (n=17, 85 %) spine. Common primary tumor types included prostate (n=4), lung (n=2), and plasma cell (n=2) cancers. Most pedicle screws (92 %) were classified as GRS A in patients with postoperative imaging. Post-operative complications were unrelated to the use of the robot, and included pulmonary embolism (n=1), deep vein thrombosis (n=2), and gastric symptoms (n=3). Three patients were readmitted at 30 days, with one reoperation due to tumor recurrence. Four patients were deceased within 6 months of surgery. CONCLUSIONS Despite the inherent high-risk nature of these surgeries, this study underscores the safety and efficacy of robotic-assisted surgery in the management of spinal metastases. Robots can be helpful in ensuring accuracy of pedicle screw placement in patients with metastatic disease.
Collapse
Affiliation(s)
- Arjun K Menta
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Carly Weber-Levine
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kelly Jiang
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Andrew M Hersh
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - A Daniel Davidar
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Meghana Bhimreddy
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kimberly Ashayeri
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Louis Chang
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Daniel Lubelski
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Nicholas Theodore
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, USA.
| |
Collapse
|
8
|
Wang Y, Song N, Zhang J, Li J, Li R, Wang L. Systematic evaluation of vertebral bone quality score as an opportunistic screening method for BMD in spine surgery patients. 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; 33:3261-3267. [PMID: 38671248 DOI: 10.1007/s00586-024-08284-9] [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: 12/08/2023] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE This study aimed to evaluate and compare the predictive value of vertebral bone quality (VBQ) score for low BMD and osteoporosis. Furthermore, we sought to enhance diagnostic effectiveness by integrating VBQ with easily accessible patient-specific factors. METHODS We retrospectively analyzed data from 180 patients. VBQ was obtained by preoperative MRI. Low BMD was classified as meeting the standards for either osteopenia or osteoporosis. The receiver operating characteristic curve analysis and multivariate logistic regression were used to detect the ability of variables to assess BMD. The z-test was used to compare the area under the curves of different variables. RESULTS VBQ was more effective in identifying low BMD than osteoporosis (AUC, 0.768 vs. 0.613, p = 0.02). Elevated VBQ (OR 6.912, 95% CI 2.72-17.6) and low BMI (0.858, 0.76-0.97) were risk factors for low BMD, while the risk factor for osteoporosis was age (1.067, 1.02-1.12), not VBQ. ROC analysis showed that AUCs were 0.613 for VBQ and 0.665 for age when screening for osteoporosis. The combined variable of VBQ, sex, age, and BMI obtained by logistic regression significantly improved the efficacy of BMD screening, with an AUC of 0.824 for low BMD and 0.733 for osteoporosis. CONCLUSION VBQ is better at detecting low BMD than identifying osteoporosis. The ability of VBQ to predict osteoporosis is limited, and a similar diagnostic efficacy can be achieved with age. Incorporating VBQ alongside demographic data enhances the efficiency of BMD assessment. With the development of artificial intelligence in medicine, this simple method is promising.
Collapse
Affiliation(s)
- Yunsheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Ning Song
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
- Department of Operating Room, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jiali Zhang
- Department of Pharmacology, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jia Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Ruoyu Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Qiaoxi District, 139 Ziqiang Road, Shijiazhuang, 050051, China.
- Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, Hebei, China.
| |
Collapse
|
9
|
Razzouk J, Bouterse A, Shin D, Mbumbgwa P, Brandt Z, Patel M, Nguyen K, Cheng W, Danisa O, Ramos O. Correlations among MRI-based cervical and thoracic vertebral bone quality score, CT-based Hounsfield Unit score, and DEXA t-score in assessment of bone mineral density. J Clin Neurosci 2024; 126:63-67. [PMID: 38850762 DOI: 10.1016/j.jocn.2024.06.001] [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: 03/22/2024] [Revised: 05/31/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Further optimization of the validated vertebral bone quality (VBQ) score using magnetic resonance imaging (MRI) may expand its clinical utility for bone mineral density (BMD) assessment. This study evaluated the correlations among cervical and thoracic VBQ scores, the validated Hounsfield Unit (HU) measured on computed tomography (CT), and dual-energy x-ray absorptiometry (DEXA) values. METHODS We retrieved the medical and radiographic records of 165 patients who underwent synchronous MRI of the cervical and thoracic spine, as well as DEXA and CT imaging of the spine obtained within 1 year of each other between 2015 and 2022. Radiographic data consisted of the MRI-based cervical and thoracic VBQ scores, CT-based HU, and DEXA T-scores of the spine and hip. Patient age, sex, body mass index (BMI), and ethnicity were also obtained. RESULTS Mean cervical and thoracic VBQ scores were 3.99 ± 1.68 and 3.82 ± 2.11, respectively. Mean HU and DEXA T-scores of the spine and hip were 135.75 ± 60.36, -1.01 ± 1.15, and -0.47 ± 2.27. All correlations among VBQ, HU, and DEXA were insignificant except for weak correlations between cervical and thoracic VBQ, and cervical VBQ and HU. No correlations were observed between radiographic scores and patient age or BMI. No differences based on ethnicity or sex were observed with respect to cervical or thoracic VBQ, HU, or DEXA. CONCLUSION Cervical and thoracic VBQ scores are distinct from Hounsfield Unit and DEXA values. VBQ scoring in the cervical and thoracic spine is not influenced by patient age, ethnicity, sex, or BMI.
Collapse
Affiliation(s)
- Jacob Razzouk
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | | | - David Shin
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | | | - Zachary Brandt
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Meghna Patel
- School of Medicine, University of California, Riverside, Riverside, CA, USA
| | - Kai Nguyen
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Wayne Cheng
- Division of Orthopaedic Surgery, Jerry L. Pettis Memorial Veterans Hospital, Loma Linda, CA, USA
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA, USA.
| | - Omar Ramos
- Twin Cities Spine Center, Minneapolis, MN, USA
| |
Collapse
|
10
|
Li D, Lu X, Gong Z, Liu S, Xu G, Wang H, Lu F, Xia X, Jiang J, Zhang X, Zou F, Ma X. Evaluation of the modified MRI vertebral bone quality score for bone quality in lumbar degenerative disorders. 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; 33:3230-3241. [PMID: 38602526 DOI: 10.1007/s00586-024-08228-3] [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: 12/12/2023] [Revised: 12/12/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE The traditional VBQ scoring method may lead to overestimation due to the concentration of intravertebral fat and vascular structures in the posterior half of vertebral bodies, potentially resulting in false-positive outcomes. This study aims to modify the measurement method of VBQ score (Modified-VBQ) and evaluate its effectiveness in evaluating bone quality of lumbar degenerative diseases. METHODS Retrospective analysis was conducted on clinical data from patients undergoing lumbar surgery for degenerative diseases between September 2022 and September 2023. Preoperative lumbar t1-weighted Magnetic resonance imaging was used for both modified and traditional VBQ scoring. Computed tomography (CT) images and dual-energy X-ray absorptiometry (DEXA) data were collected through the picture archiving and communication system. The effectiveness of the modified VBQ score was evaluated, considering P < 0.05 as statistically significant. RESULTS The study included 212 patients, revealing a significant difference between the modified VBQ and VBQ scores (P < 0.0001). Notably, patients with a history of hyperlipidemia exhibited a significant difference between the two scores (P = 0.0037). The area under the ROC curve (AUC) for the modified VBQ was 0.86, surpassing the VBQ score (AUC = 0.74). Linear regression analysis demonstrated a moderate to strong correlation between the modified VBQ and DEXA T-score (r = - 0.49, P < 0.0001) and a high correlation with CT Hounsfield units (HU) values (r = - 0.60, P < 0.0001). CONCLUSION The modified VBQ score provides a simple, effective, and relatively accurate means of assessing bone quality in lumbar degenerative diseases. Preoperative implementation of the modified VBQ score facilitates rapid screening for patients with abnormal bone quality.
Collapse
Affiliation(s)
- Dachuan Li
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Xiao Lu
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Zhaoyang Gong
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Siyang Liu
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Guangyu Xu
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China.
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Feizhou Lu
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Xinlei Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China
| | - Xuesen Zhang
- Department of Orthopedics, Wuzhong People's Hospital, 143 Xinmin Road, Litong District, Wuzhong, 751100, Ningxia, China
| | - Fei Zou
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China.
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Jing'an District, Shanghai, 200040, China.
| |
Collapse
|
11
|
Tsuchiya K, Okano I, Kobayashi R, Dodo Y, Ogawa J, Hara E, Taketomi A, Kudo Y. Quantitative Assessment of Intervertebral Disc Degeneration Using the Disc Signal Intensity Index in Patients With Spine-Related Pain. Cureus 2024; 16:e63553. [PMID: 39087185 PMCID: PMC11290383 DOI: 10.7759/cureus.63553] [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] [Accepted: 06/30/2024] [Indexed: 08/02/2024] Open
Abstract
Objective This is a retrospective observational study that aims to investigate the association between disc signal intensity index (DSI2) scores and patient-reported outcome measures in patients with lumbar spine disorders. Methods We introduced DSI2 to quantitatively assess disc degeneration. MRI records of patients with lumbar spine-related pain between 2019 and 2022 were analyzed retrospectively. Patient demographics and outcomes were collected, including the Numerical Rating Scale of Pain and EuroQol Group 5 Dimension 5-Level Quality of Life (EQ-5D-5L) scores. The DSI2 was calculated by dividing the mean signal intensity of the L1-S1 discs by that of the CSF on midsagittal T2-weighted MRI images. Results Each DSI2 level corresponded to a Pfirrmann grade score at the respective lumbar level. Multivariable linear regression analysis using the EQ-5D-5L as the objective variable identified BMI (p = 0.007) and average DSI2 (p = 0.018) as independent risk factors for EQ-5D-5L deterioration. However, the mean Pfirrmann grade score was not an independent risk factor (p = 0.58). Conclusion Our study using DSI2 showed the relationship between disc degeneration and EQ-5D-5L deterioration. Distinct from the Pfirrmann grading system, the DSI2 method is a promising alternative for future disc research that excellently detects the subtle progression of degeneration.
Collapse
Affiliation(s)
- Koki Tsuchiya
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, JPN
| | - Ichiro Okano
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, JPN
| | - Reon Kobayashi
- Department of Anesthesiology, Showa University School of Medicine, Tokyo, JPN
| | - Yusuke Dodo
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, JPN
| | - Joji Ogawa
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, JPN
| | - Eiko Hara
- Department of Anesthesiology, Showa University School of Medicine, Tokyo, JPN
| | - Asae Taketomi
- Department of Anesthesiology, Showa University School of Medicine, Tokyo, JPN
| | - Yoshifumi Kudo
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, JPN
| |
Collapse
|
12
|
Patel PP, Esposito EP, Zhu J, Chen X, Khan M, Kleinberg L, Lubelski D, Theodore N, Lo SFL, Hun Lee S, Kebaish K, Bydon A, Redmond KJ. Antiresorptive Medications Prior to Stereotactic Body Radiotherapy for Spinal Metastasis are Associated with Reduced Incidence of Vertebral Body Compression Fracture. Global Spine J 2024; 14:1778-1785. [PMID: 36749660 PMCID: PMC11268289 DOI: 10.1177/21925682231156394] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVE Antiresorptive drugs are often given to minimize fracture risk for bone metastases, but data regarding optimal time or ability to reduce stereotactic body radiotherapy (SBRT)-induced fracture risk is limited. This study examines the association between antiresorptive use surrounding spinal SBRT and vertebral compression fracture (VCF) incidence to provide information regarding effectiveness and optimal timing of use. METHODS Patients treated with SBRT for spinal metastases at a single institution between 2009-2020 were included. Kaplan-Meier analysis was used to compare cumulative incidence of VCF for those taking antiresorptive drugs pre-SBRT, post-SBRT only, and none at all. Cox proportional hazards and Fine-Gray competing risk models were used to identify additional factors associated with VCF. RESULTS Of the 234 patients (410 vertebrae) analyzed, 49 (20.9%) were taking bisphosphonates alone, 42 (17.9%) were taking denosumab alone, and 25 (10.7%) were taking both. Kaplan-Meier analysis revealed a statistically significant lower VCF incidence for patients initiating antiresorptive drugs before SBRT compared to those taking none at all (4% vs 12% at 1 year post-SBRT, P = .045; and 4% vs 23% at 2 years, P = .008). On multivariate analysis, denosumab duration (HR: .87, P = .378) or dose (HR: 1.00, P = .644) as well as bisphosphonate duration (HR: .98, P= .739) or dose (HR: .99, P= .741) did not have statistical significance on VCF incidence. CONCLUSION Initiating antiresorptive agents before SBRT may reduce the risk of treatment-induced VCF. Antiresorptive drugs are underutilized in patients with spine metastases and may represent a useful intervention to minimize toxicity and improve long-term outcomes.
Collapse
Affiliation(s)
- Palak P. Patel
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Edward P. Esposito
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jiafeng Zhu
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Xuguang Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Majid Khan
- Department of Radiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Lawrence Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sheng-fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hoftstra, Manhasset, NY, USA
| | - Sang Hun Lee
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Khaled Kebaish
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ali Bydon
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kristin J. Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
13
|
Li J, Wang L, Li Q, Deng Z, Wang L, Song Y. A novel MRI-based Cervical-Endplate Bone Quality score independently predicts cage subsidence after Anterior Cervical Discectomy and Fusion. 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; 33:2277-2286. [PMID: 38643425 DOI: 10.1007/s00586-024-08250-5] [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: 12/02/2023] [Revised: 03/12/2024] [Accepted: 03/31/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Postoperative cage subsidence after Anterior Cervical Discectomy and Fusion (ACDF) often has adverse clinical consequences and is closely related to Bone Mineral Density (BMD). Previous studies have shown that cage subsidence can be better predicted by measuring site-specific bone density. MRI-based Endplate Bone Quality (EBQ) scoring effectively predicts cage subsidence after lumbar interbody fusion. However, there is still a lack of studies on the practical application of EBQ scoring in the cervical spine. PURPOSE To create a similar MRI-based scoring system for Cervical-EBQ (C-EBQ) and to assess the correlation of the C-EBQ with endplate Computed Tomography (CT)-Hounsfield Units (HU) and the ability of this scoring system to independently predict cage subsidence after ACDF, comparing the predictive ability of the C-EBQ with the Cervical-Vertebral Bone Quality (C-VBQ) score. METHODS A total of 161 patients who underwent single-level ACDF for degenerative cervical spondylosis at our institution from 2012 to 2022 were included. Demographics, procedure-related data, and radiological data were collected, and Pearson correlation test was used to determine the correlation between C-EBQ and endplate HU values. Cage subsidence was defined as fusion segment height loss of ≥ 3 mm. Receiver operating characteristic analysis and area-under-the-curve values were used to assess the predictive ability of C-EBQ and C-VBQ. A multivariate logistic regression model was developed to identify potential risk factors associated with subsidence. RESULTS Cage subsidence was present in 65 (40.4%) of 161 patients. The mean C-EBQ score was 1.81 ± 0.35 in the group without subsidence and 2.59 ± 0.58 in the group with subsidence (P < 0.001). Multivariate analysis showed that a higher C-EBQ score was significantly associated with subsidence (OR = 5.700; 95%CI = 3.435-8.193; P < 0.001), was the only independent predictor of cage subsidence after ACDF, had a predictive accuracy of 93.7%, which was superior to the C-VBQ score (89.2%), and was significantly negatively correlated with the endplate HU value (r = -0.58, P < 0.001). CONCLUSIONS Higher C-EBQ scores were significantly associated with postoperative cage subsidence after ACDF. There was a significant negative correlation between C-EBQ and endplate HU values. The C-EBQ score may be a promising tool for assessing preoperative bone quality and postoperative cage subsidence and is superior to the C-VBQ.
Collapse
Affiliation(s)
- Junhu Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Linnan Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Qiujiang Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhipeng Deng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Lei Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, 610041, People's Republic of China
| |
Collapse
|
14
|
Jiang G, Xu L, Ma Y, Guan J, Yang Y, Zhong W, Li W, Zhou S, Song J, Feng N, Qiu Z, Li Z, Zhou Y, Meng L, Qu Y, Yu X. Prediction of Screw Loosening After Dynamic Pedicle Screw Fixation With Lumbar Polyetheretherketone Rods Using Magnetic Resonance Imaging-Based Vertebral Bone Quality Score. Neurospine 2024; 21:712-720. [PMID: 38955540 PMCID: PMC11224750 DOI: 10.14245/ns.2448184.092] [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: 02/28/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To investigate the correlation between magnetic resonance imaging-based vertebral bone quality (VBQ) score and screw loosening after dynamic pedicle screw fixation with polyetheretherketone (PEEK) rods, and evaluate its predictive value. METHODS A retrospective analysis was conducted on the patients who underwent dynamic pedicle screw fixation with PEEK rods from March 2017 to June 2022. Data on age, sex, body mass index, hypertension, diabetes, hyperlipidemia history, long-term smoking, alcohol consumption, VBQ score, L1-4 average Hounsfield unit (HU) value, surgical fixation length, and the lowest instrumented vertebra were collected. Logistic regression analysis was employed to assess the relationship between VBQ score and pedicle screw loosening (PSL). RESULTS A total of 24 patients experienced PSL after surgery (20.5%). PSL group and non-PSL group showed statistical differences in age, number of fixed segments, fixation to the sacrum, L1-4 average HU value, and VBQ score (p < 0.05). The VBQ score in the PSL group was higher than that in the non-PSL group (3.56 ± 0.45 vs. 2.77 ± 0.31, p < 0.001). In logistic regression analysis, VBQ score (odds ratio, 3.425; 95% confidence interval, 1.552-8.279) were identified as independent risk factors for screw loosening. The area under the receiver operating characteristic curve for VBQ score predicting PSL was 0.819 (p < 0.05), with the optimal threshold of 3.15 (sensitivity, 83.1%; specificity, 80.5%). CONCLUSION The VBQ score can independently predict postoperative screw loosening in patients undergoing lumbar dynamic pedicle screw fixation with PEEK rods, and its predictive value is comparable to HU value.
Collapse
Affiliation(s)
- Guozheng Jiang
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Luchun Xu
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Yukun Ma
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Jianbin Guan
- Department of Neurosurgery, Honghui-Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yongdong Yang
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Wenqing Zhong
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Wenhao Li
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Shibo Zhou
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - JiaWei Song
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Ningning Feng
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Ziye Qiu
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Zeyu Li
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - YiShu Zhou
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Letian Meng
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Yi Qu
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Xing Yu
- Department of Neurosurgery, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| |
Collapse
|
15
|
Pennington Z, Mikula AL, Lakomkin N, Martini M, Pinter ZW, Shafi M, Hamouda A, Bydon M, Clarke MJ, Freedman BA, Krauss WE, Nassr AN, Sebastian AS, Fogelson JL, Elder BD. Bone Quality as Measured by Hounsfield Units More Accurately Predicts Proximal Junctional Kyphosis than Vertebral Bone Quality Following Long-Segment Thoracolumbar Fusion. World Neurosurg 2024; 186:e584-e592. [PMID: 38588791 DOI: 10.1016/j.wneu.2024.04.003] [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: 01/15/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To compare the prognostic power of Hounsfield units (HU) and Vertebral Bone Quality (VBQ) score for predicting proximal junctional kyphosis (PJK) following long-segment thoracolumbar fusion to the upper thoracic spine (T1-T6). METHODS Vertebral bone quality around the upper instrumented vertebrae (UIV) was measured using HU on preoperative CT and VBQ on preoperative MRI. Spinopelvic parameters were also categorized according to the Scoliosis Research Society-Schwab classification. Univariable analysis to identify predictors of the occurrence of PJK and survival analyses with Kaplan-Meier method and Cox regression were performed to identify predictors of time to PJK (defined as ≥10° change in Cobb angle of UIV+2 and UIV). Sensitivity analyses showed thresholds of HU < 164 and VBQ > 2.7 to be most predictive for PJK. RESULTS Seventy-six patients (mean age 66.0 ± 7.0 years; 27.6% male) were identified, of whom 15 suffered PJK. Significant predictors of PJK were high postoperative pelvic tilt (P = 0.038), high postoperative T1-pelvic angle (P = 0.041), and high postoperative PI-LL mismatch (P = 0.028). On survival analyses, bone quality, as assessed by the average HU of the UIV and UIV+1 was the only significant predictor of time to PJK (odds ratio [OR] 3.053; 95% CI 1.032-9.032; P = 0.044). VBQ measured using the UIV, UIV+1, UIV+2, and UIV-1 vertebrae approached, but did not reach significance (OR 2.913; 95% CI 0.797-10.646; P = 0.106). CONCLUSIONS In larger cohorts, VBQ may prove to be a significant predictor of PJK following long-segment thoracolumbar fusion. However, Hounsfield units on CT have greater predictive power, suggesting preoperative workup for long-segment thoracolumbar fusion benefits from computed tomography versus magnetic resonance imaging alone to identify those at increased risk of PJK.
Collapse
Affiliation(s)
- Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Anthony L Mikula
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nikita Lakomkin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Martini
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Zachariah W Pinter
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mahnoor Shafi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle J Clarke
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - William E Krauss
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmad N Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arjun S Sebastian
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy L Fogelson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
16
|
Yang DD, Li Y, Tian JY, Li Y, Liu J, Liu YS, Cao XW, Liu C. MRI-based vertebral bone quality score as a novel bone status marker of patients with adolescent idiopathic scoliosis. Sci Rep 2024; 14:12518. [PMID: 38822099 PMCID: PMC11143181 DOI: 10.1038/s41598-024-63426-9] [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: 01/09/2024] [Accepted: 05/29/2024] [Indexed: 06/02/2024] Open
Abstract
To investigate the application of MRI-based vertebral bone quality (VBQ) score in assessing bone mineral density (BMD) for patients with adolescent idiopathic scoliosis (AIS). We reviewed the data of AIS patients between January 2021 and October 2023 with MRI, whole-spine plain radiographs, quantitative computed tomography (QCT) and general information. VBQ score was calculated using T1-weighted MRI. Univariate analysis was applied to present the differences between variables of patients with normal BMD group (QCT Z-score > - 2.0) and low BMD group (QCT Z-score ≤ - 2.0). The correlation between VBQ score and QCT Z-score was analyzed with Pearson correlation test. A multivariate logistic regression model was used to determine the independent factors related to low BMD. Receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic performance of VBQ score in distinguishing low BMD. A total of 136 AIS patients (mean age was 14.84 ± 2.10 years) were included, of which 41 had low BMD. The low BMD group had a significantly higher VBQ score than that in normal group (3.48 ± 0.85 vs. 2.62 ± 0.62, P < 0.001). The VBQ score was significantly negative correlated with QCT Z score (r = - 0.454, P < 0.001). On multivariate analysis, VBQ score was independently associated with low BMD (OR: 4.134, 95% CI 2.136-8.000, P < 0.001). The area under the ROC curve indicated that the diagnostic accuracy of the VBQ score for predicting low BMD was 81%. A sensitivity of 65.9% with a specificity of 88.4% could be achieved for distinguishing low BMD by setting the VBQ score cutoff as 3.18. The novel VBQ score was a promising tool in distinguishing low BMD in patients with AIS and could be useful as opportunistic assessment for screening and complementary evaluation to QCT before surgery.
Collapse
Affiliation(s)
- Dan-Dan Yang
- Radiology Department, The Third People's Hospital of Chengdu, No. 82 Qinglong Road, Qingyang District, Chengdu, 610031, Sichuan, China
| | - Yi Li
- Radiology Department, The Third People's Hospital of Chengdu, No. 82 Qinglong Road, Qingyang District, Chengdu, 610031, Sichuan, China
| | - Jiang-Yu Tian
- Radiology Department, The Third People's Hospital of Chengdu, No. 82 Qinglong Road, Qingyang District, Chengdu, 610031, Sichuan, China
| | - Ya Li
- Radiology Department, The Third People's Hospital of Chengdu, No. 82 Qinglong Road, Qingyang District, Chengdu, 610031, Sichuan, China
| | - Jian Liu
- Radiology Department, The Third People's Hospital of Chengdu, No. 82 Qinglong Road, Qingyang District, Chengdu, 610031, Sichuan, China
| | - Yun-Song Liu
- Radiology Department, The Third People's Hospital of Chengdu, No. 82 Qinglong Road, Qingyang District, Chengdu, 610031, Sichuan, China
| | - Xin-Wen Cao
- Radiology Department, The Third People's Hospital of Chengdu, No. 82 Qinglong Road, Qingyang District, Chengdu, 610031, Sichuan, China
| | - Chuan Liu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, No. 20 Renmin South Road, Wuhou District, Chengdu, 610044, Sichuan, China.
| |
Collapse
|
17
|
Xue C, Lu X, Sun G, Wang N, He G, Xu W, Xi Z, Xie L. Opportunistic prediction of osteoporosis in patients with degenerative lumbar diseases: a simplified T12 vertebral bone quality approach. J Orthop Surg Res 2024; 19:296. [PMID: 38750513 PMCID: PMC11094894 DOI: 10.1186/s13018-024-04782-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/05/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Osteoporosis is one of the risk factors for screw loosening after lumbar fusion. However, the probability of preoperative osteoporosis screening in patients with lumbar degenerative disease is low. Therefore, the aim of this study was to investigate whether a simplified vertebral bone quality (VBQ) score based on T12 T1-MRI could opportunistically predict osteoporosis in patients with degenerative lumbar spine diseases. METHODS We retrospectively analyzed cases treated for lumbar degenerative diseases at a single institution between August 2021 and June 2022. The patients were divided into three groups by the lowest T-score: osteoporosis group, osteopenia group, and normal bone mineral density (BMD) group. The signal intensity based on the T12 vertebral body divided by the signal intensity of the cerebrospinal fluid was calculated to obtain the simplified VBQ score, as well as the CT-based T12HU value and the traditional L1-4VBQ score. Various statistical analyses were used to compare VBQ, HU and DEXA, and the optimal T12VBQ threshold for predicting osteoporosis was obtained by plotting the receiver operating curve (ROC) analysis. RESULTS Total of 166 patients were included in this study. There was a statistically significant difference in T12VBQ scores between the three groups (p < 0.001). Pearson correlation showed that there was a moderate correlation between T12VBQ and T-score (r=-0.406, p < 0.001). The AUC value of T12VBQ, which distinguishes between normal and low BMD, was 0.756, and the optimal diagnostic threshold was 2.94. The AUC value of T12VBQ, which distinguishes osteoporosis from non-osteoporosis, was 0.634, and the optimal diagnostic threshold was 3.18. CONCLUSION T12VBQ can be used as an effective opportunistic screening method for osteoporosis in patients with lumbar degenerative diseases. It can be used as a supplement to the evaluation of DEXA and preoperative evaluation. TRIAL REGISTRATION retrospectively registered number:1502-009-644; retrospectively registered number date:27 oct 2022.
Collapse
Affiliation(s)
- Congyang Xue
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Xiaopei Lu
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Guangda Sun
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Nan Wang
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Ganshen He
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Wenqiang Xu
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Zhipeng Xi
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Lin Xie
- Department of Orthopedic, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100th. Shizi Street, Nanjing, Jiangsu Province, 210028, P.R. China.
| |
Collapse
|
18
|
Wang S, Hu Y, Liu H, Yang K, Zhang X, Qu B, Yang H. Simplified S1 Vertebral Bone Quality Score in the Assessment of Patients with Vertebral Fragility Fractures. World Neurosurg 2024; 185:e1004-e1012. [PMID: 38462067 DOI: 10.1016/j.wneu.2024.03.011] [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: 11/18/2023] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of the S1 vertebral bone quality (VBQ) score in assessing bone quality among patients with vertebral fragility fractures (VFF). Additionally, whether the combination of S1 VBQ and Hounsfield unit (HU) values improves the predictive accuracy of VFF. METHODS Using lumbar noncontrast computed tomography and T1-weighted magnetic resonance imaging, we measured L1 HU values, S1 VBQ, and L1-L4 VBQ. To assess their predictive performance for VFF, we constructed receiver operating characteristic curves. We also compared the diagnostic efficacy of HU values with that of S1 VBQ and L1--L4 VBQ values for the joint diagnosis of VFF. The Delong test was used to compare the value of individual or combined predictions of VFF. RESULTS In comparison to the nonfracture group, all patients exhibited markedly elevated S1 VBQ and L1--L4 VBQ and notably reduced HU values (P < 0.001). Multivariate analysis revealed that elevated S1 VBQ, increased L1--L4 VBQ, and decreased HU values independently correlated with VFF development. The areas under the curve for VFF prediction were 0.806 for S1 VBQ, 0.799 for L1--L4 VBQ, and 0.820 for HU values. According to the Delong test, the combination of HU values with S1 VBQ/L1--L4 VBQ significantly improved the diagnostic accuracy. CONCLUSIONS The simplified S1 VBQ is a valuable tool for predicting the occurrence of VFF and can be used as an alternative to the L1--L4 VBQ. In addition, the combination of S1 VBQ and HU values can significantly improve the predictive value of VFF.
Collapse
Affiliation(s)
- Song Wang
- School of clinical medicine, Chengdu Medical College, Sichuan, China
| | - Yongrong Hu
- School of clinical medicine, Chengdu Medical College, Sichuan, China
| | - Hao Liu
- Department of Orthopaedics, First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Kunhai Yang
- School of clinical medicine, Chengdu Medical College, Sichuan, China
| | - Xiang Zhang
- School of clinical medicine, Chengdu Medical College, Sichuan, China
| | - Bo Qu
- Department of Orthopaedics, First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Hongsheng Yang
- Department of Orthopaedics, First Affiliated Hospital of Chengdu Medical College, Sichuan, China.
| |
Collapse
|
19
|
Patel M, Razzouk J, Shin D, Cabrera AJ, Nguyen K, Bouterse A, Mbumbgwa P, Brandt Z, Cheng W, Danisa O, Ramos O. Association Between Vertebral Bone Quality Score and Dual-Energy X-ray Absorptiometry for the Assessment of Bone Mineral Density in Adolescent Patients. Cureus 2024; 16:e53402. [PMID: 38440006 PMCID: PMC10911640 DOI: 10.7759/cureus.53402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The MRI-based vertebral bone quality (VBQ) score is an assessment tool for bone mineral density (BMD) that has been validated in adults against the clinical standard of dual-energy X-ray absorptiometry (DEXA). However, VBQ has yet to be validated against DEXA for use in adolescents. This study evaluated the associations between adolescent VBQ scores, DEXA Z-scores, and BMD values. METHODS The radiographic records of 63 consecutive patients between the ages of 11 and 21 who underwent MRI of the abdomen and pelvis and DEXA of the spine and hip were retrieved. The collected radiographic data consisted of the MRI-based VBQ score, DEXA Z-score, and BMD values of the femoral neck, L1-4 vertebrae, and total body. The VBQ score was calculated by taking the median signal intensity (MSI) from L1-L4 and the SI of the L3 cerebrospinal fluid (CSF). The VBQ score was derived as the quotient of MSIL1-L4 divided by SICSF. RESULTS A mean VBQ score of 2.41 ± 0.29 was observed. Strong correlations of -0.749 (p<0.0001) and -0.780 (p<0.0001) were detected between the VBQ score and DEXA femoral neck and spine Z-scores, respectively. Correlations between VBQ score and DEXA femoral neck, spine, and total body BMD scores were -0.559 (p<0.0001), -0.611 (p<0.0001), and -0.516 (p<.0001), respectively. No significant correlations were found between the VBQ score and age, BMI, weight, or height. A mean difference in VBQ score of -0.155 (p=0.035) was observed between sexes. VBQ demonstrated moderate predictive ability for DEXA-derived Z-scores and BMD scores. CONCLUSIONS VBQ scores were strongly correlated with DEXA Z-scores and moderately correlated with BMD values. The VBQ score can also be used by adolescent patients as an accessory tool to assess bone health.
Collapse
Affiliation(s)
- Meghna Patel
- School of Medicine, University of California, Riverside, Riverside, USA
| | - Jacob Razzouk
- School of Medicine, Loma Linda University, Loma Linda, USA
| | - David Shin
- School of Medicine, Loma Linda University, Loma Linda, USA
| | | | - Kai Nguyen
- School of Medicine, Loma Linda University, Loma Linda, USA
| | - Alex Bouterse
- School of Medicine, Loma Linda University, Loma Linda, USA
| | | | - Zachary Brandt
- School of Medicine, Loma Linda University, Loma Linda, USA
| | - Wayne Cheng
- Department of Orthopedic Surgery, Jerry L. Pettis Veterans Affairs (VA) Medical Center, Loma Linda, USA
| | - Olumide Danisa
- Department of Orthopedic Surgery, Loma Linda University, Loma Linda, USA
| | - Omar Ramos
- Department of Spine Surgery, Twin Cities Spine Center, Minneapolis, USA
| |
Collapse
|
20
|
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
|
21
|
Yu W, Zhang H, Yao Z, Zhong Y, Jiang X, Cai D. Lower ratio of adjacent to injured vertebral bone quality scores can predict augmented vertebrae recompression following percutaneous kyphoplasty for osteoporotic vertebral fractures with intravertebral clefts. Pain Pract 2023; 23:892-903. [PMID: 37401521 DOI: 10.1111/papr.13266] [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: 11/21/2022] [Revised: 04/14/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Despite the favorable clinical outcome of percutaneous kyphoplasty (PKP) in symptomatic osteoporotic vertebral fractures (OVFs) patients with intravertebral clefts (IVCs), previous studies have demonstrated a high incidence of augmented vertebrae recompression (AVR). We aim to evaluate the usefulness of the adjacent and injured vertebral bone quality scores (VBQS) based on T1-weighted MRI images in AVR after PKP for OVFs with IVCs. METHODS Patients who underwent PKP for single OVFs with IVCs between January 2014 and September 2020 were reviewed and met the inclusion criteria. The follow-up period was at least 2 years. Relevant data affecting AVR were collected. Pearson and Spearman correlation coefficients were used to calculate the correlation between the injured and adjacent VBQS and BMD T-score. We determined independent risk factors and critical values using binary logistic regression analysis and receiver operating characteristic curves (ROC). RESULTS A total of 165 patients were included. Recompression group was found in 42 (25.5%) patients. The independent risk factors for AVR were lumbar BMD T-score (OR = 2.53, p = 0.003), the adjacent VBQS (OR = 0.79, p = 0.016), the injured VBQS (OR = 1.27, p = 0.048), the ratio of adjacent to injured VBQS (OR = 0.32, p < 0.001), and cement distribution pattern. Among these independent significant risk factors, the prediction accuracy of the ratio of adjacent to injured VBQS was the highest (Cutoff = 1.41, AUC = 0.753). Additionally, adjacent and injured VBQS were negatively correlated with lumbar BMD T-scores. CONCLUSION For the patients after PKP treatment for OVFs with IVCs, the ratio of adjacent to injured VBQS had the best prediction accuracy in predicting recompression and when the ratio of adjacent to injured VBQS was <1.41, the augmented vertebrae were more likely to have recompression in the future.
Collapse
Affiliation(s)
- Weibo Yu
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Haiyan Zhang
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Zhensong Yao
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuanming Zhong
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Daozhang Cai
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| |
Collapse
|
22
|
Xu TT, Huang XY, Jiang YW. Efficacy of two opportunistic methods for screening osteoporosis in lumbar spine surgery patients. 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 2023; 32:3912-3918. [PMID: 37715792 DOI: 10.1007/s00586-023-07938-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/06/2023] [Accepted: 08/30/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Hounsfield unit (HU) measurements and vertebral bone quality (VBQ) scores are opportunistic screening methods for evaluating bone quality. Since studies comparing the efficacies of the two methods are rare, this retrospective study aimed to examine the efficacy of VBQ scores compared with that of HU measurements for diagnosing osteoporosis in lumbar spine surgery patients. METHODS We selected patients who had undergone spinal surgery between January 2020 and May 2022 from our database. The VBQ scores based on magnetic resonance imaging (MRI) and HU measurements based on computed tomography (CT) were calculated. Correlation analysis of the dual-energy X-ray absorptiometry (DEXA) T score and study parameters was performed. The Delong test and decision curve analysis (DCA) were used to compare the efficacies of the two methods. RESULTS We included 118 consecutive patients who underwent selective spinal surgery. The VBQ score and HU measurement were significantly correlated with the DEXA T score. Based on the Delong test, HU measurement predicted osteoporosis more effectively than the VBQ score did. The DCA revealed that the VBQ score performed better than the HU measurement did. CONCLUSIONS The calculation of VBQ scores is a novel opportunistic screening method for diagnosing osteoporosis; however, CT-based HU measurements outperform MRI-based VBQ scores. HU measurements can be used as a screening method when pre-operative CT scans are available.
Collapse
Affiliation(s)
- Ting-Ting Xu
- Fujian Medical University, Fuzhou City, 350001, Fujian Province, China
| | - Xue-Ying Huang
- Fujian Medical University, Fuzhou City, 350001, Fujian Province, China
| | - Yan-Wei Jiang
- Department of Neurosurgery, Fujian Medical University Union Hospital, No.29 Xinquan, Fuzhou City, 350001, Fujian Province, China.
- Fujian Medical University, Fuzhou City, 350001, Fujian Province, China.
| |
Collapse
|
23
|
Liu XG, Chen X, Chen B, Liang PJ, Liu HH, Fu M. Vertebral bone quality different in magnetic resonance imaging parameters. J Orthop Surg Res 2023; 18:772. [PMID: 37828514 PMCID: PMC10571331 DOI: 10.1186/s13018-023-04268-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE This was a single-center retrospective study that aimed to measure the vertebral bone quality (VBQ) in people of all ages and compare changes in VBQ across ages. Differences in VBQ under various MRI parameters were compared. METHODS We first screened patients without underlying disease and no history of fractures who underwent lumbar MRI in our center in the past four years. Over the span of 10 years, 200 patients (100 males and 100 females) were randomly recruited into each cohort to undergo 1.5 T and 3.0 T MRI scans. Subsequently, we tabulated the number of patients admitted to our hospital with OVCF over the past four years. There were 30 healthy adults under 4 times of MRI scans in different parameters to determine the differentiation of VBQ. The 30 healthy adults were recruited to validate the differentiation of VBQ under various parameters. RESULTS A total of 2400 patients without OVCF and 405 patients with OVCF were enrolled. The VBQ value of 1.5 T was significantly higher compared with that of 3.0 T (2.769 ± 0.494 > 2.199 ± 0.432, P < 0.0001). VBQ of 43.31 kHz in 1.5 T was significantly lower than that of 35.36 kHz (2.447 ± 0.350 < 2.632 ± 0.280, P < 0.05). The differentiation of VBQ in 1.5 T and 3.0 T was validated using results of healthy adults. CONCLUSIONS VBQ is an effective tool for differentiating patients with OVCF and can be used as a primary screening tool for osteoporosis. However, VBQ is significantly affected by magnetic field intensity and bandwidth and cannot achieve its universality as it originally proposed.
Collapse
Affiliation(s)
- Xiang-Ge Liu
- Department of Spinal Surgery, Foshan Fosun Chancheng Hospital, Fosun Group, Foshan, 528000, China
| | - Xin Chen
- Department of Spinal Surgery, Foshan Fosun Chancheng Hospital, Fosun Group, Foshan, 528000, China
| | - Biao Chen
- Department of Spinal Surgery, Foshan Fosun Chancheng Hospital, Fosun Group, Foshan, 528000, China
| | - Pei-Jie Liang
- Department of Spinal Surgery, Foshan Fosun Chancheng Hospital, Fosun Group, Foshan, 528000, China
| | - Han-Hui Liu
- Department of Spinal Surgery, Foshan Fosun Chancheng Hospital, Fosun Group, Foshan, 528000, China
| | - Meiqi Fu
- Department of Spinal Surgery, Foshan Fosun Chancheng Hospital, Fosun Group, Foshan, 528000, China.
| |
Collapse
|
24
|
Yin H, Lin W, Xie F, He C, Chen T, Zheng G, Wang Z. MRI-based Vertebral Bone Quality Score for Osteoporosis Screening Based on Different Osteoporotic Diagnostic Criteria Using DXA and QCT. Calcif Tissue Int 2023; 113:383-392. [PMID: 37493798 DOI: 10.1007/s00223-023-01115-x] [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: 03/30/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023]
Abstract
In this study, we aim to evaluate the correlation between T score measured by dual X-ray absorptiometry (DXA), volumetric bone mineral density (vBMD) derived from quantitative computed tomography (QCT) and MRI-based vertebral bone quality (VBQ), explore the diagnostic performance of VBQ in osteoporosis and determine the recognition value of VBQ in osteoporotic fracture in a relatively large cohort of elderly patients scheduled to undergo spinal surgery. A total of 260 patients were enrolled in the study. DXA and QCT were used to evaluate osteoporotic status. We calculated the lumbar VBQ score, analyzed the correlation between T score, vBMD and VBQ, and explored whether VBQ was an influential factor of bone quality and fracture by binary logistic regression as well as the diagnostic performance of VBQ in osteoporosis and fracture by ROC curve. VBQ was negatively correlated with vBMD and T score. (r = - 0.487 vs. r = - 0.220). The VBQ score was a risk factor for osteoporosis under the QCT diagnostic criteria (OR = 2.245, 95% CI 1.456-3.460) and osteoporotic fractures (OR = 1.496, 95% CI 1.097-2.040). It exhibited superior discriminant performance for osteoporosis diagnosed by QCT, with a cutoff value of 3.70 and an AUC of 0.7354. Its cutoff value for osteoporotic fractures was 3.72, and its AUC was 0.6717. In a cohort of elderly patients scheduled to undergo spinal surgery, the VBQ score was more strongly associated with vBMD than the T score and could identify patients with osteoporosis and corresponding vertebral compression fracture (VCF).
Collapse
Affiliation(s)
- Houjie Yin
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
- The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Wentao Lin
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Faqin Xie
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
| | - Chaoqin He
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
- The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Tao Chen
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
- The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Guanghao Zheng
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China
- The Second Clinical Medical College of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhiyun Wang
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Foshan, Guangdong, China.
| |
Collapse
|
25
|
Li W, Zhu H, Tian H, Tong T, Hua Z, Zhao X, Shen Y, Wang L. Combinations of two imaging parameters to improve bone mineral density (BMD) assessment in patients with lumbar degenerative diseases. BMC Musculoskelet Disord 2023; 24:747. [PMID: 37735402 PMCID: PMC10512586 DOI: 10.1186/s12891-023-06888-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE To explore whether combining the Hounsfield unit (HU) values and vertebral bone quality (VBQ) scores can improve the BMD assessment in patients with lumbar degenerative diseases. METHODS The HU values were measured by CT image, and VBQ scores were calculated by lumbar MRI image. The correlations of the opportunistic imaging parameters to the lowest T-scores were analyzed. Receiver-operating characteristic curve (ROC) analysis was used to evaluate the accuracy in detecting osteoporosis. Finally, the specificity and sensitivity of different combined methods of the HU values and VBQ scores in the diagnosis of osteoporosis were compared. RESULTS Patients with osteoporosis had the lowest HU values and the highest VBQ scores. The correlation coefficients between the VBQ scores and the T-scores were smaller than HU values (L1 HU value: 0.702; average HU value:0.700; L1 VBQ score: -0.413; VBQ score: -0.386). The areas under the curve (AUCs) of the HU values were greater than those of the VBQ scores, and the AUCs of the L1 VBQ score were similar to the VBQ score (L1 HU value: 0.850; average HU value:0.857; L1 VBQ score: 0.704; VBQ score: 0.673). When combining the two imaging parameters in series, the specificity of the detection of osteoporosis was improved (L1 HU value and L1 VBQ score: 87.3%; Average HU value and VBQ score: 85.9%). When combining the two imaging parameters in parallel, the sensitivity of the detection of osteoporosis was improved (L1 HU value or L1 VBQ score: 88.1%; Average HU value or VBQ score: 91.5%). CONCLUSIONS Combinations of the HU values and VBQ scores could improve the diagnostic performance of osteoporosis. In addition, considering the same diagnostic performance but easier measurement, parameters at the single-segment level were recommended to assist in the diagnosis of osteoporosis.
Collapse
Affiliation(s)
- Wenshuai Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Houze Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Hongsen Tian
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Tong Tong
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Zijian Hua
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Xuan Zhao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Yong Shen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China.
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
| |
Collapse
|
26
|
Li W, Zhu H, Liu J, Tian H, Li J, Wang L. Characteristics of MRI‑based vertebral bone quality scores in elderly patients with vertebral fragility fractures. 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 2023; 32:2588-2593. [PMID: 37133764 DOI: 10.1007/s00586-023-07744-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/17/2023] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To explore the characteristics of vertebral bone quality (VBQ) scores in patients with vertebral fragility fractures, including VBQ score and single-level VBQ score, and evaluate their effectiveness as predictors. METHODS The VBQ scores were measured using T1-weighted MRI images. VBQ scores were compared in patients with different times of previous fragility fractures. In addition, patients with fractures were matched for age and sex with patients without fractures, and VBQ scores were compared between the two groups. Finally, the predictive efficiency of VBQ scores for vertebral fragility fractures was analyzed by the receiver-operator curve (ROC). RESULTS The average VBQ score and single-level VBQ score in patients with fractures were 3.48 ± 0.56 and 3.60 ± 0.60 and no difference among patients with different times of previous fractures. As for the age- and sex-matched patients, fracture patients had higher VBQ scores (VBQ score: 3.48 ± 0.56 vs. 2.88 ± 0.40, p < 0.001; single-level VBQ score: 3.60 ± 0.60 vs. 2.95 ± 0.44, p < 0.001). The AUCs using the VBQ score and single-level VBQ score to predict fragility fractures were 0.815 and 0.817, respectively. The optimal thresholds of the VBQ score and single-level VBQ score for predicting fragility fractures were 3.22 and 3.16, respectively. CONCLUSION MRI‑based VBQ scores are important predictors of vertebral fragility fracture but have no predictive value for the recurrence of fractures in patients with a history of fragility fractures. The VBQ score of 3.22 and single-level VBQ score of 3.16 are optimal thresholds that can be used when using lumbar MRI scans to identify individuals at high risk for fragility fractures.
Collapse
Affiliation(s)
- Wenshuai Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Houze Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Junchuan Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Hongsen Tian
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Jia Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Linfeng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, People's Republic of China.
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
| |
Collapse
|
27
|
Oezel L, Okano I, Jones C, Salzmann SN, Shue J, Adl Amini D, Moser M, Chiapparelli E, Sama AA, Carrino JA, Cammisa FP, Girardi FP, Hughes AP. MRI-based vertebral bone quality score compared to quantitative computed tomography bone mineral density in patients undergoing cervical spinal surgery. 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 2023; 32:1636-1643. [PMID: 36882579 DOI: 10.1007/s00586-023-07570-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE The vertebral bone quality (VBQ) score based on magnetic resonance imaging (MRI) was introduced as a bone quality marker in the lumbar spine. Prior studies showed that it could be utilized as a predictor of osteoporotic fracture or complications after instrumented spine surgery. The objective of this study was to evaluate the correlation between VBQ scores and bone mineral density (BMD) measured by quantitative computer tomography (QCT) in the cervical spine. METHODS Preoperative cervical CT and sagittal T1-weighted MRIs from patients undergoing ACDF were retrospectively reviewed and included. The VBQ score in each cervical level was calculated by dividing the signal intensity of the vertebral body by the signal intensity of the cerebrospinal fluid on midsagittal T1-weighted MRI images and correlated with QCT measurements of the C2-T1 vertebral bodies. A total of 102 patients (37.3% female) were included. RESULTS VBQ values of C2-T1 vertebrae strongly correlated with each other. C2 showed the highest VBQ value [Median (range) 2.33 (1.33, 4.23)] and T1 showed the lowest VBQ value [Median (range) 1.64 (0.81, 3.88)]. There was significant weak to moderate negative correlations between and VBQ Scores for all levels [C2: p < 0.001; C3: p < 0.001; C4: p < 0.001; C5: p < 0.004; C6: p < 0.001; C7: p < 0.025; T1: p < 0.001]. CONCLUSION Our results indicate that cervical VBQ scores may be insufficient in the estimation of BMDs, which might limit their clinical application. Additional studies are recommended to determine the utility of VBQ and QCT BMD to evaluate their potential use as bone status markers.
Collapse
Affiliation(s)
- Lisa Oezel
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, University Hospital Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Ichiro Okano
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Conor Jones
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Stephan N Salzmann
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Dominik Adl Amini
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedic Surgery and Traumatology, Charité University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - John A Carrino
- Department of Radiology and Imaging, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| |
Collapse
|
28
|
Soliman MAR, Aguirre AO, Kuo CC, Ruggiero N, Khan A, Ghannam MM, Rho K, Jowdy PK, Mullin JP, Pollina J. A Novel Cervical Vertebral Bone Quality Score Independently Predicts Cage Subsidence After Anterior Cervical Diskectomy and Fusion. Neurosurgery 2023; 92:779-786. [PMID: 36729684 DOI: 10.1227/neu.0000000000002269] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/23/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Surgeons can preoperatively assess bone quality using dual-energy X-ray absorptiometry or computed tomography; however, this is not feasible for all patients. Recently, a MRI-based scoring system was used to evaluate the lumbar spine's vertebral bone quality. OBJECTIVE To create a similar MRI-based scoring system for the cervical spine (C-VBQ), correlate C-VBQ scores with computed tomography-Hounsfield units (HU), and evaluate the utility of this scoring system to independently predict cage subsidence after single-level anterior cervical diskectomy and fusion (ACDF). METHODS Demographic, procedure-related, and radiographic data were collected for patients. Pearson correlation test was used to determine the correlation between C-VBQ and HU. Cage subsidence was defined as ≥3 mm loss of fusion segmental height. A multivariate logistic regression model was built to determine the correlation between potential risk factors for subsidence. RESULTS Of 59 patients who underwent single-level ACDF, subsidence was found in 17 (28.8%). Mean C-VBQ scores were 2.22 ± 0.36 for no subsidence levels and 2.83 ± 0.38 ( P < .001) for subsidence levels. On multivariate analysis, a higher C-VBQ score was significantly associated with subsidence (odds ratio = 1.85, 95% CI = 1.39-2.46, P < .001) and was the only significant independent predictor of subsidence after ACDF. There was a significant negative correlation between HU and C-VBQ (r 2 = -0.49, P < .001). CONCLUSION We found that a higher C-VBQ score was significantly associated with cage subsidence after ACDF. Furthermore, there was a significant negative correlation between C-VBQ and HU. The C-VBQ score may be a valuable tool for assessing preoperative bone quality and independently predicting cage subsidence after ACDF.
Collapse
Affiliation(s)
- Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Nicco Ruggiero
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Moleca M Ghannam
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Kyungduk Rho
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Patrick K Jowdy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| |
Collapse
|
29
|
Schömig F, Becker L, Schönnagel L, Völker A, Disch AC, Schnake KJ, Pumberger M. Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review. Global Spine J 2023; 13:52S-58S. [PMID: 37084355 PMCID: PMC10177307 DOI: 10.1177/21925682231159066] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES With an aging population, the prevalence of osteoporosis is continuously rising. As osseous integrity is crucial for bony fusion and implant stability, previous studies have shown osteoporosis to be associated with an increased risk for implant failure and higher reoperation rates after spine surgery. Thus, our review's purpose was to provide an update of evidence-based solutions in the surgical treatment of osteoporosis patients. METHODS We summarize the existing literature regarding changes associated with decreased bone mineral density (BMD) and resulting biomechanical implications for the spine as well as multidisciplinary treatment strategies to avoid implant failures in osteoporotic patients. RESULTS Osteoporosis is caused by an uncoupling of the bone remodeling cycle based on an unbalancing of bone resorption and formation and resulting reduced BMD. The reduction in trabecular structure, increased porosity of cancellous bone and decreased cross-linking between trabeculae cause a higher risk of complications after spinal implant-based surgeries. Thus, patients with osteoporosis require special planning considerations, including adequate preoperative evaluation and optimization. Surgical strategies aim towards maximizing screw pull-out strength, toggle resistance, as well as primary and secondary construct stability. CONCLUSIONS As osteoporosis plays a crucial role in the fate of patients undergoing spine surgery, surgeons need to be aware of the specific implications of low BMD. While there still is no consensus on the best course of treatment, multidisciplinary preoperative assessment and adherence to specific surgical principles help reduce the rate of implant-related complications.
Collapse
Affiliation(s)
- Friederike Schömig
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Luis Becker
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lukas Schönnagel
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Völker
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Alexander C Disch
- University Comprehensive Spine Center, University Center for Orthopedics, Traumatology and Plastic Surgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Klaus John Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St Marien gGmbH, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
30
|
Huang Y, Chen Q, Liu L, Feng G. Vertebral bone quality score to predict cage subsidence following oblique lumbar interbody fusion. J Orthop Surg Res 2023; 18:258. [PMID: 36991489 DOI: 10.1186/s13018-023-03729-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Current evidence suggests that the magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score is a good parameter for evaluating bone quality. We aimed to assess whether the VBQ score can predict the occurrence of postoperative cage subsidence after oblique lumbar interbody fusion (OLIF) surgery. METHODS Patients (n = 102) who had undergone single-level OLIF with a minimal follow-up for 1 year were reviewed in this study. Demographic and radiographic data of these patients were collected. Cage subsidence was defined as ≥ 2 mm of cage migration into the inferior endplate, superior endplate, or both. Further, the MRI-based VBQ score was measured on T1-weighted images. Moreover, univariable and multivariable binary logistic regression analyses were performed. Meanwhile, Pearson analysis was used to evaluate the correlation among the VBQ score, average lumbar dual-energy X-ray absorptiometry (DEXA) T-score, and degree of cage subsidence. Furthermore, ad-hoc analysis was used along with receiver operating characteristic curve analysis to assess the predictive ability of the VBQ score and average lumbar DEXA T-score. RESULTS Of 102 participants, cage subsidence was observed in 39 (38.24%) patients. According to the univariable analysis, patients with subsidence had older age, higher antiosteoporotic drug use, larger disk height change, a more concave morphology of inferior and superior endplates, higher VBQ score, and lower average lumbar DEXA T-score compared to patients without subsidence. In the multivariable logistic regression analysis, a higher VBQ score was significantly associated with an increased risk of subsidence (OR = 23.158 ± 0.849, 95% CI 4.381-122.399, p < 0.001), and it was the only significant and independent predictor of subsidence after OLIF. Moreover, the VBQ score was moderately correlated with the average lumbar DEXA T-score (r = - 0.576, p < 0.001) and the amount of cage subsidence (r = 0.649, p < 0.001). Furthermore, this score significantly predicted cage subsidence with an accuracy of 83.9%. CONCLUSIONS The VBQ score can independently predict postoperative cage subsidence in patients undergoing OLIF surgery.
Collapse
Affiliation(s)
- Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
31
|
Chen Z, Lei F, Ye F, Yuan H, Li S, Feng D. MRI-based vertebral bone quality score for the assessment of osteoporosis in patients undergoing surgery for lumbar degenerative diseases. J Orthop Surg Res 2023; 18:257. [PMID: 36991471 DOI: 10.1186/s13018-023-03746-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE To explore the value of vertebral bone quality (VBQ) scores in diagnosing osteoporosis in patients with lumbar degeneration. METHODS A retrospective analysis was conducted of 235 patients treated with lumbar fusion surgery at the age of ≥ 50; they were divided into a degenerative group and a control group according to the severity of degenerative changes on three-dimensional computed tomography. The L1-4 vertebral body and L3 cerebrospinal fluid signal intensities in the T1-weighted lumbar magnetic resonance imaging (MRI) image were recorded, and the VBQ score was calculated. Demographics, clinical data, and dual-energy X-ray absorptiometry (DXA) indicators were recorded, and the VBQ value was compared with bone density and T-score using the Pearson correlation coefficient. The VBQ threshold was obtained according to the control group and compared with the efficacy of osteoporosis diagnosis based on DXA. RESULTS A total of 235 patients were included in the study, and the age of the degenerative group was older than that of the control group (61.8 vs. 59.4, P = 0.026). The VBQ score of the control group suggested a higher correlation with the bone mineral density (BMD) value and T-score (r = - 0.611 and - 0.62, respectively). The BMD value and T-score in the degenerative group were higher than those in the control group (P < 0.05). Receiver-operating characteristic curve analysis showed that the VBQ score had a good predictive ability for osteoporosis (AUC = 0.818), with a sensitivity of 93% and a specificity of 65.4%. Among the undiagnosed osteoporosis patients with T-score, the VBQ score after adjusting the threshold was higher in the degenerative group (46.9% vs. 30.8%). CONCLUSIONS Emerging VBQ scores can reduce the interference caused by degenerative changes compared to traditional DXA measures. Screening for osteoporosis in patients undergoing lumbar spine surgery provides new ideas.
Collapse
Affiliation(s)
- Zan Chen
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Fei Lei
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Fei Ye
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Hao Yuan
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Songke Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Daxiong Feng
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.
| |
Collapse
|
32
|
Razzouk J, Ramos O, Ouro-Rodrigues E, Samayoa C, Wycliffe N, Cheng W, Danisa O. Comparison of cervical, thoracic, and lumbar vertebral bone quality scores for increased utility of bone mineral density screening. 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 2023; 32:20-26. [PMID: 36509887 DOI: 10.1007/s00586-022-07484-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/22/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the associations among the validated lumbar vertebral bone quality (VBQ) score, and cervical and thoracic VBQ scores. METHODS Radiographic records of 100 patients who underwent synchronous MRI of the cervical, thoracic, and lumbar spine were retrieved. DEXA-validated lumbar VBQ was calculated using median signal intensity (MSI) of the L1-L4 vertebrae and L3 CSF. VBQ was derived as the quotient of MSIL1-L4 divided by MSICSF. Cervical and thoracic VBQ were similarly obtained using C3-C6 and C5 CSF, and T5-T8 and T7 CSF, respectively. Paired sample t-tests were used to evaluate differences among regional VBQ scores. Independent sample t-tests were used to identify sex differences in VBQ. Regression models with one-way analysis of variance (ANOVA) were constructed to identify associations among all permutations of anthropometric and regional VBQ measures. RESULTS Mean cervical, thoracic, and lumbar VBQ scores were 3.06 ± 0.89, 2.60 ± 0.77, and 2.47 ± 0.61, respectively. Mean differences of .127 (p = 0.045) and - 0.595 (p < 0.001) were observed between thoracic and lumbar, and cervical and lumbar VBQ scores. Correlations of 0.324, 0.356, and 0.600 (p < 0.001) were found between cervical and lumbar, cervical and thoracic, and thoracic and lumbar VBQ scores. Regression with ANOVA predicting lumbar VBQ in relation to cervical and thoracic VBQ demonstrated R Square values of 0.105 and 0.360 (p < 0.001), and β coefficient values of 0.471 and 0.217 (p < 0.001), respectively. CONCLUSION Thoracic VBQ provides values representative of the validated lumbar VBQ score. Cervical VBQ scores are distinct from lumbar VBQ scores and do not provide adequate surrogate values of lumbar VBQ.
Collapse
Affiliation(s)
- Jacob Razzouk
- School of Medicine, Loma Linda University, Loma Linda, CA, USA.
- , 11252 Walnut Street, Redlands, CA, 92374, USA.
| | - Omar Ramos
- Department of Orthopaedic Surgery, Loma Linda University Health, Loma Linda Drive, Suite 213, Loma Linda, CA, 11406, USA
| | | | - Carlos Samayoa
- Patient Safety and Reliability, Loma Linda University, Loma Linda, CA, USA
| | - Nathaniel Wycliffe
- Department of Radiology, Loma Linda University Health, Loma Linda, CA, USA
| | - Wayne Cheng
- Division of Orthopaedic Surgery, Jerry L. Pettis VA Medical Center, Loma Linda, CA, USA
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University Health, Loma Linda Drive, Suite 213, Loma Linda, CA, 11406, USA
| |
Collapse
|
33
|
Kuo CC, Soliman MAR, Aguirre AO, Ruggiero N, Kruk M, Khan A, Ghannam MM, Almeida ND, Jowdy PK, Smolar DE, Pollina J, Mullin JP. Vertebral Bone Quality Score Independently Predicts Proximal Junctional Kyphosis and/or Failure After Adult Spinal Deformity Surgery. Neurosurgery 2022; 92:945-954. [PMID: 36700747 DOI: 10.1227/neu.0000000000002291] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) can be catastrophic complications associated with adult spinal deformity (ASD) surgery. These complications are markedly influenced by osteoporosis, leading to additional vertebral fracture and pedicle screw loosening. The MRI-based vertebral bone quality score (VBQ) is a newly developed tool that can be used to assess bone quality. OBJECTIVE To investigate the utility of the VBQ score in predicting PJK and/or PJF (PJF/PJK) after ASD correction. METHODS We conducted a retrospective chart review to identify patients age ≥50 years who had received ASD surgery of 5 or more thoracolumbar levels. Demographic, spinopelvic parameters, and procedure-related variables were collected. Each patient's VBQ score was calculated using preoperative T1-weighted MRI. Univariate analysis and multivariate logistic regression were performed to determine potential risk factors of PJK/PJF. Receiver operating characteristic analysis and area-under-the-curve values were generated for prediction of PJK/PJF. RESULTS A total of 116 patients were included (mean age, 64.1 ± 6.8 years). Among them, 34 patients (29.3%) developed PJK/PJF. Mean VBQ scores were 3.13 ± 0.46 for patients with PJK/PJF and 2.46 ± 0.49 for patients without, which was significantly different between the 2 groups ( P < .001). On multivariate analysis, VBQ score was the only significant predictor of PJK/PJF (odds ratio = 1.745, 95% CI = 1.558-1.953, P < .001), with a predictive accuracy of 94.3%. CONCLUSION In patients undergoing ASD correction, higher VBQ was independently associated with PJK/PJF occurrence. Measurement of VBQ score on preoperative MRI may be a useful adjunct to ASD surgery planning.
Collapse
Affiliation(s)
- Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.,Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Nicco Ruggiero
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Marissa Kruk
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Moleca M Ghannam
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Neil D Almeida
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Patrick K Jowdy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - David E Smolar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.,Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| |
Collapse
|
34
|
Hu YH, Yeh YC, Niu CC, Hsieh MK, Tsai TT, Chen WJ, Lai PL. Novel MRI-based vertebral bone quality score as a predictor of cage subsidence following transforaminal lumbar interbody fusion. J Neurosurg Spine 2022; 37:654-662. [PMID: 35561693 DOI: 10.3171/2022.3.spine211489] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Decreased bone mineral density as measured by dual-energy x-ray absorptiometry (DEXA) has been reported to be associated with cage subsidence following transforaminal lumbar interbody fusion (TLIF). However, DEXA is not often available or routinely performed before surgery. A novel MRI-based vertebral bone quality (VBQ) score has been developed and reported to be correlated with DEXA T-scores. The authors investigated the ability of the VBQ score to predict cage subsidence and other risk factors associated with this complication. METHODS In this retrospective study, the authors reviewed the records of patients who had undergone single-level TLIF from March 2014 to October 2015 and had a follow-up of more than 2 years. Cage subsidence was measured as postoperative disc height loss and was graded according to the system proposed by Marchi et al. The MRI-based VBQ score was measured on T1-weighted images. Univariable analysis and multivariable binary logistic regression analysis were performed. Ad hoc analysis with receiver operating characteristic curve analysis was performed to assess the predictive ability of the significant continuous variables. Additional analyses were used to determine the correlations between the VBQ score and T-scores and between the significant continuous variables and the amount of cage subsidence. RESULTS Among 242 patients eligible for study inclusion, 111 (45.87%) had cage subsidence after the index operation. Multivariable logistic regression analyses demonstrated that an increased VBQ score (OR 14.615 ± 0.377, p < 0.001), decreased depth ratio (OR 0.011 ± 1.796, p = 0.013), and the use of kidney-shaped cages instead of bullet-shaped cages (OR 2.766 ± 0.358, p = 0.008) were associated with increased cage subsidence. The VBQ score was shown to significantly predict cage subsidence with an accuracy of 85.6%. The VBQ score was found to be moderately correlated with DEXA T-scores of the total hip (r = -0.540, p < 0.001) and the lumbar spine (r = -0.546, p < 0.001). The amount of cage subsidence was moderately correlated with the VBQ score (r = 0.512, p < 0.001). CONCLUSIONS Increased VBQ scores, posteriorly placed cages, and kidney-shaped cages were risk factors for cage subsidence. The VBQ score was shown to be a good predictor of cage subsidence, was moderately correlated with DEXA T-scores for the total hip and lumbar spine, and also had a moderate correlation with the amount of cage subsidence.
Collapse
Affiliation(s)
- Yung-Hsueh Hu
- 1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- 2Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
- 3College of Medicine, Chang Gung University, Taoyuan; and
| | - Yu-Cheng Yeh
- 1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- 2Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
- 3College of Medicine, Chang Gung University, Taoyuan; and
| | - Chi-Chien Niu
- 1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- 2Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
- 3College of Medicine, Chang Gung University, Taoyuan; and
| | - Ming-Kai Hsieh
- 1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- 2Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
- 3College of Medicine, Chang Gung University, Taoyuan; and
| | - Tsung-Ting Tsai
- 1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- 2Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
- 3College of Medicine, Chang Gung University, Taoyuan; and
| | - Wen-Jer Chen
- 4Department of Orthopedic Surgery, Chung Shan Hospital, Taipei, Taiwan
| | - Po-Liang Lai
- 1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- 2Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
- 3College of Medicine, Chang Gung University, Taoyuan; and
| |
Collapse
|
35
|
Ramos O, Razzouk J, Chung JH, Cheng WK, Danisa OA. Opportunistic assessment of bone density in patients with adolescent idiopathic scoliosis using MRI-based vertebral bone quality. J Clin Neurosci 2022; 103:41-43. [DOI: 10.1016/j.jocn.2022.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
|
36
|
Salzmann SN, Okano I, Jones C, Zhu J, Lu S, Onyekwere I, Balaji V, Reisener MJ, Chiapparelli E, Shue J, Carrino JA, Girardi FP, Cammisa FP, Sama AA, Hughes AP. Preoperative MRI-based vertebral bone quality (VBQ) score assessment in patients undergoing lumbar spinal fusion. Spine J 2022; 22:1301-1308. [PMID: 35342015 DOI: 10.1016/j.spinee.2022.03.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 02/14/2022] [Accepted: 03/17/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The importance of bone status assessment in spine surgery is well recognized. The current gold standard for assessing bone mineral density is dual-energy X-ray absorptiometry (DEXA). However, DEXA has been shown to overestimate BMD in patients with spinal degenerative disease and obesity. Consequently, alternative radiographic measurements using data routinely gathered during preoperative evaluation have been explored for the evaluation of bone quality and fracture risk. Opportunistic quantitative computed tomography (QCT) and more recently, the MRI-based vertebral bone quality (VBQ) score, have both been shown to correlate with DEXA T-scores and predict osteoporotic fractures. However, to date the direct association between VBQ and QCT has not been studied. PURPOSE The objective of this study was to evaluate the correlation between VBQ and spine QCT BMD measurements and assess whether the recently described novel VBQ score can predict the presence of osteopenia/osteoporosis diagnosed with QCT. STUDY DESIGN/SETTING Cross-sectional study using retrospectively collected data. PATIENT SAMPLE Patients undergoing lumbar fusion from 2014-2019 at a single, academic institution with available preoperative lumbar CT and T1-weighted MRIs were included. OUTCOME MEASURES Correlation of the VBQ score with BMD measured by QCT, and association between VBQ score and presence of osteopenia/osteoporosis. METHODS Asynchronous QCT measurements were performed. The average L1-L2 BMD was calculated and patients were categorized as either normal BMD (>120 mg/cm3) or osteopenic/osteoporotic (≤120 mg/cm3). The VBQ score was calculated by dividing the median signal intensity of the L1-L4 vertebral bodies by the signal intensity of the cerebrospinal fluid on midsagittal T1-weighted MRI images. Inter-observer reliability testing of the VBQ measurements was performed. Demographic data and the VBQ score were compared between the normal and osteopenic/osteoporotic group. To determine the area-under-curve (AUC) of the VBQ score as a predictor of osteopenia/osteoporosis receiver operating characteristic (ROC) analysis was performed. VBQ scores were compared with QCT BMD using the Pearson's correlation. RESULTS A total of 198 patients (53% female) were included. The mean age was 62 years and the mean BMI was 28.2 kg/m2. The inter-observer reliability of the VBQ measurements was excellent (ICC of 0.90). When comparing the patients with normal QCT BMD to those with osteopenia/osteoporosis, the patients with osteopenia/osteoporosis were significantly older (64.9 vs. 56.7 years, p<.0001). The osteopenic/osteoporotic group had significantly higher VBQ scores (2.6 vs. 2.2, p<.0001). The VBQ score showed a statistically significant negative correlation with QCT BMD (correlation coefficient = -0.358, 95% CI -0.473 - -0.23, p<.001). Using a VBQ score cutoff value of 2.388, the categorical VBQ score yielded a sensitivity of 74.3% and a specificity of 57.0% with an AUC of 0.7079 to differentiate patients with osteopenia/osteoporosis and with normal BMD. CONCLUSIONS We found that the VBQ score showed moderate diagnostic ability to differentiate patients with normal BMD versus osteopenic/osteoporotic BMD based on QCT. VBQ may be an interesting adjunct to clinically performed bone density measurements in the future.
Collapse
Affiliation(s)
- Stephan N Salzmann
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - Ichiro Okano
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - Conor Jones
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - Jiaqi Zhu
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - Shuting Lu
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - Ikenna Onyekwere
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - Venkatesh Balaji
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - Marie-Jacqueline Reisener
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - Erika Chiapparelli
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - Jennifer Shue
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - John A Carrino
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - Federico P Girardi
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - Frank P Cammisa
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - Andrew A Sama
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA
| | - Alexander P Hughes
- Hospital for Special Surgery, Weill Cornell Medicine, Spine Care Institute, 535 East 70th St, New York, NY 10021, USA.
| |
Collapse
|
37
|
MRI-based vertebral bone quality score effectively reflects bone quality in patients with osteoporotic vertebral compressive fractures. 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 2022; 31:1131-1137. [PMID: 35316408 DOI: 10.1007/s00586-022-07177-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/23/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The present study is aimed to validate the ability of the vertebral bone quality (VBQ) score to evaluate bone quality in patients with osteoporotic vertebral compression fractures (OVCF) and to compare it with the ability of T-score by DXA. In addition, the sensitivity of VBQ score with cerebrospinal fluid (CSF) of L2 and L3 segments as baseline is evaluated. METHODS 196 inpatients were collected and assigned into OVCF and Non-OVCF groups, respectively. For each patient, the VBQ score was calculated by the signal intensity of the L1-L4 vertebral bodies and CSF at L3 or L2 level from T1-weighted MRIs, while T-score from DXA was also obtained. The VBQ and T-score was compared between OVCF and non-OVCF groups, and among age groups. The OVCF ORs by VBQ score and T-score were calculated using logistic regression. RESULTS OVCF group was significantly different to the non-OVCF group in the T-score (- 2.9 vs. - 0.7) and VBQ score (4.0 vs. 3.5). VBQ score and T-score in patient aged 60-79 years old could indicate the bone quality, but only T-score in patients aged 50-59 years old. OVCF are associated with both higher VBQ score and lower T-score. The VBQ scores calculated by L2 CSF and L3 CSF were similar. CONCLUSIONS The VBQ score is an effective indicator of bone quality in OVCF patients and comparable to T-score, particularly in people over 60 years old. The VBQ score is not sensitive to CSF of different segments as a baseline.
Collapse
|
38
|
Abstract
The technique of 3D printing offers a high potential for further optimization of spinal surgery. This new technology has been published for different areas in the field of spinal surgery, e.g. in preoperative planning, intraoperative use as well as to create patient-specific implants. For example, it has been demonstrated that preoperative 3‑dimensional visualization of spinal deformities is helpful in planning procedures. Moreover, insertion of pedicle screws seems to be more accurate when using individualized templates to guide the drill compared to freehand techniques. This review summarizes the current literature dealing with 3D printing in spinal surgery with special consideration of the current applications, the limitations and the future potential.
Collapse
|
39
|
Lafage R, Smith JS, Elysee J, Passias P, Bess S, Klineberg E, Kim HJ, Shaffrey C, Burton D, Hostin R, Mundis G, Ames C, Schwab F, Lafage V. Sagittal age-adjusted score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications. Spine Deform 2022; 10:121-131. [PMID: 34460094 DOI: 10.1007/s43390-021-00397-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Several methodologies have been proposed to determine ideal ASD sagittal spinopelvic alignment (SRS-Schwab classification) global alignment and proportion (GAP) score, patient age-adjusted alignment). A recent study revealed the ability and limitations of these methodologies to predict PJK. The aim of the study was to develop a new approach, inspired by SRS classification, GAP score, and age-alignment to improve the evaluation of the sagittal plane. METHOD A multi-center ASD database was retrospectively evaluated for surgically treated ASD patients with complete fusion of the lumbar spine, and minimum 2 year follow-up. The Sagittal age-adjusted score (SAAS) methodology was created by assigning numerical values to the difference between each patient's postoperative sagittal alignment and ideal alignment defined by previously reported age generational norms for PI-LL, PT, and TPA. Postoperative HRQOL and PJK severity between each SAAS categories were evaluated. RESULTS 409 of 667 (61.3%) patients meeting inclusion criteria were evaluated. At 2 year SAAS score showed that 27.0% of the patients were under-corrected, 51.7% over-corrected, and 21.3% matched their age-adjusted target. SAAS score increased as PJK worsened (from SAAS = 0.2 for no-PJK, to 4.0 for PJF, p < 0.001). Post-operatively, HRQOL differences between SAAS groups included ODI, SRS pain, and SRS total. CONCLUSION Inspired by SRS classification, the concept of the GAP score, and age-adjusted alignment targets, the results demonstrated significant association with PJK and patient reported outcomes. With a lower rate of failure and better HRQOL, the SAAS seems to represent a "sweet spot" to optimize HRQOL while mitigating the risk of mechanical complications.
Collapse
Affiliation(s)
- Renaud Lafage
- Department of Orthopedics, Hospital for Special Surgery, 525 E 71st St., Belaire 4E, New York, NY, 10021, USA.
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Jonathan Elysee
- Department of Orthopedics, Hospital for Special Surgery, 525 E 71st St., Belaire 4E, New York, NY, 10021, USA
| | - Peter Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Shay Bess
- Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Sacramento, Davis, CA, USA
| | - Han Jo Kim
- Department of Orthopedics, Hospital for Special Surgery, 525 E 71st St., Belaire 4E, New York, NY, 10021, USA
| | | | - Douglas Burton
- Department of Orthopaedics, University of Kansas Medical Center, Kansas, KS, USA
| | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX, USA
| | | | - Christopher Ames
- Department of Neurological Surgery, School of Medicine, University of California, San Francisco, CA, USA
| | - Frank Schwab
- Department of Orthopedics, Hospital for Special Surgery, 525 E 71st St., Belaire 4E, New York, NY, 10021, USA
| | - Virginie Lafage
- Department of Orthopedics, Hospital for Special Surgery, 525 E 71st St., Belaire 4E, New York, NY, 10021, USA
| | | |
Collapse
|
40
|
Chang HK, Hsu TW, Ku J, Ku J, Wu JC, Lirng JF, Hsu SM. Simple parameters of synthetic MRI for assessment of bone density in patients with spinal degenerative disease. J Neurosurg Spine 2021:1-8. [PMID: 34653988 DOI: 10.3171/2021.6.spine21666] [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: 05/11/2021] [Accepted: 06/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Good bone quality is the key to avoiding osteoporotic fragility fractures and poor outcomes after lumbar instrumentation and fusion surgery. Although dual-energy x-ray absorptiometry (DEXA) screening is the current standard for evaluating osteoporosis, many patients lack DEXA measurements before undergoing lumbar spine surgery. The present study aimed to investigate the utility of using simple quantitative parameters generated with novel synthetic MRI to evaluate bone quality, as well as the correlations of these parameters with DEXA measurements. METHODS This prospective study enrolled patients with symptomatic lumbar degenerative disease who underwent DEXA and conventional and synthetic MRI. The quantitative parameters generated with synthetic MRI were T1 map, T2 map, T1 intensity, proton density (PD), and vertebral bone quality (VBQ) score, and these parameters were correlated with T-score of the lumbar spine. RESULTS There were 62 patients and 238 lumbar segments eligible for analysis. PD and VBQ score moderately correlated with T-score of the lumbar spine (r = -0.565 and -0.651, respectively; both p < 0.001). T1 intensity correlated fairly well with T-score (r = -0.411, p < 0.001). T1 and T2 correlated poorly with T-score. Receiver operating characteristic curve analysis demonstrated area under the curve values of 0.808 and 0.794 for detecting osteopenia/osteoporosis (T-score ≤ -1.0) and osteoporosis (T-score ≤ -2.5) with PD (both p < 0.001). CONCLUSIONS PD and T1 intensity values generated with synthetic MRI demonstrated significant correlation with T-score. PD has excellent ability for predicting osteoporosis and osteopenia.
Collapse
Affiliation(s)
- Hsuan-Kan Chang
- 1Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,2College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,3Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tun-Wei Hsu
- 4Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,5Integrated PET/MR Imaging Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Johnson Ku
- 6University of California, Los Angeles, California; and
| | - Jason Ku
- 6University of California, Los Angeles, California; and
| | - Jau-Ching Wu
- 2College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,3Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,7Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiing-Feng Lirng
- 2College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,4Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ming Hsu
- 1Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
41
|
Schilling AT, Ehresman J, Pennington Z, Cottrill E, Feghali J, Ahmed AK, Hersh A, Planchard RF, Jin Y, Lubelski D, Khan M, Redmond KJ, Witham T, Lo SFL, Sciubba DM. Interrater and Intrarater Reliability of the Vertebral Bone Quality Score. World Neurosurg 2021; 154:e277-e282. [PMID: 34252629 DOI: 10.1016/j.wneu.2021.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Vertebral bone quality had a significant impact on postoperative outcomes in spinal fusion surgery. New magnetic resonance imaging-based measures, such as the Vertebral Bone Quality (VBQ) score, may allow for bone quality assessment without the radiation associated with conventional testing. In the present study, we sought to assess the intrarater and interrater reliability of VBQ scores calculated by medical professionals and trainees. METHODS Thirteen reviewers of various specialties and levels of training were recruited and asked to calculate VBQ scores for 30 patients at 2 time points separated by 2 months. Scored volumes were acquired from patients treated for both degenerative and oncologic indications. Intrarater and interrater agreement, quantified by intraclass correlation coefficient (ICC), was assessed using 2-way random effects modeling. Square-weight Cohen κ and Kendall Tau-b were used to determine whether raters assigned similar scores during both evaluations. RESULTS All raters showed moderate to excellent reliability for VBQ score (ICC 0.667-0.957; κ0.648-0.921) and excellent reliability for all constituent components used to calculate VBQ score (ICC all ≥0.97). Interrater reliability was also found to be good for VBQ score on both the first (ICC = 0.818) and second (ICC = 0.800) rounds of assessment; scores for the constituent component all had ICC values ≥0.97 for the constituent components. CONCLUSIONS The VBQ score appears to have both good intrarater and interrater reliability. In addition, there appeared to be no correlation between score reliability and level of training. External validation and further investigations of its ability to accurately model bone biomechanical properties are necessary.
Collapse
Affiliation(s)
- Andrew T Schilling
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James Feghali
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ryan F Planchard
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yike Jin
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Majid Khan
- Department of Radiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Kristin J Redmond
- Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York, USA.
| |
Collapse
|
42
|
Assessing underlying bone quality in spine surgery patients: a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives. Spine J 2021; 21:321-331. [PMID: 32890786 DOI: 10.1016/j.spinee.2020.08.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/15/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023]
Abstract
Poor bone quality and low bone mineral density (BMD) have been previously tied to higher rates of postoperative mechanical complications in patients undergoing spinal fusion. These include higher rates of proximal junctional kyphosis, screw pullout, pseudoarthrosis, and interbody subsidence. For these reasons, accurate preoperative assessment of a patient's underlying bone quality is paramount for all elective procedures. Dual-energy X-ray absorptiometry (DXA) is currently considered to be the gold standard for assessing BMD. However, a growing body of research has suggested that in vivo assessments of BMD using DXA are inaccurate and have, at best, moderate correlations to postoperative mechanical complications. Consequently, there have been investigations into using alternative methods for assessing in vivo bone quality, including using computed tomography (CT) and magnetic resonance imaging (MRI) volumes that are commonly obtained as part of surgical evaluation. Here we review the data regarding the accuracy of DXA for the evaluation of spine bone quality and describe the alternative imaging modalities currently under investigation.
Collapse
|
43
|
Whyne CM, Ferguson D, Clement A, Rangrez M, Hardisty M. Biomechanical Properties of Metastatically Involved Osteolytic Bone. Curr Osteoporos Rep 2020; 18:705-715. [PMID: 33074529 DOI: 10.1007/s11914-020-00633-z] [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] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Skeletal metastasis involves the uncoupling of physiologic bone remodeling resulting in abnormal bone turnover and radical changes in bony architecture, density, and quality. Bone strength assessment and fracture risk prediction are critical in clinical treatment decision-making. This review focuses on bone tissue and structural mechanisms altered by osteolytic metastasis and the resulting changes to its material and mechanical behavior. RECENT FINDINGS Both organic and mineral phases of bone tissue are altered by osteolytic metastatic disease, with diminished bone quality evident at multiple length-scales. The mechanical performance of bone with osteolytic lesions is influenced by a combination of tissue-level and structural changes. This review considers the effects of osteolytic metastasis on bone biomechanics demonstrating its negative impact at tissue and structural levels. Future studies need to assess the cumulative impact of cancer treatments on metastatically involved bone quality, and its utility in directing multimodal treatment planning.
Collapse
Affiliation(s)
- Cari M Whyne
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.
- Department of Surgery, University of Toronto, Toronto, Canada.
- Biomedical Engineering, University of Toronto, Toronto, Canada.
| | - Dallis Ferguson
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
- Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Allison Clement
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Mohammedayaz Rangrez
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Michael Hardisty
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| |
Collapse
|
44
|
Witham TF, Cottrill E, Pennington Z. Editorial. Is preoperative bone health assessment and optimization in spine surgery a good idea? Neurosurg Focus 2020; 49:E3. [PMID: 32738807 DOI: 10.3171/2020.5.focus20414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|