Delayed Neurological Deficits after Osteoporotic Vertebral Fractures: Clinical Outcomes after Surgery

Weakly supervised deep learning for diagnosis of multiple vertebral compression fractures in CT

OBJECTIVE

This study aims to develop a weakly supervised deep learning (DL) model for vertebral-level vertebral compression fracture (VCF) classification using image-level labelled data.

METHODS

The training set included 815 patients with normal (n = 507, 62%) or VCFs (n = 308, 38%). Our proposed model was trained on image-level labelled data for vertebral-level classification. Another supervised DL model was trained with vertebral-level labelled data to compare the performance of the proposed model.

RESULTS

The test set included 227 patients with normal (n = 117, 52%) or VCFs (n = 110, 48%). For a fair comparison of the two models, we compared sensitivities with the same specificities of the proposed model and the vertebral-level supervised model. The specificity for overall L1-L5 performance was 0.981. The proposed model may outperform the vertebral-level supervised model with sensitivities of 0.770 vs 0.705 (p = 0.080), respectively. For vertebral-level analysis, the specificities for each L1-L5 were 0.974, 0.973, 0.970, 0.991, and 0.995, respectively. The proposed model yielded the same or better sensitivity than the vertebral-level supervised model in L1 (0.750 vs 0.694, p = 0.480), L3 (0.793 vs 0.586, p < 0.05), L4 (0.833 vs 0.667, p = 0.480), and L5 (0.600 vs 0.600, p = 1.000), respectively. The proposed model showed lower sensitivity than the vertebral-level supervised model for L2, but there was no significant difference (0.775 vs 0.825, p = 0.617).

CONCLUSIONS

The proposed model may have a comparable or better performance than the supervised model in vertebral-level VCF classification.

CLINICAL RELEVANCE STATEMENT

Vertebral-level vertebral compression fracture classification aids in devising patient-specific treatment plans by identifying the precise vertebrae affected by compression fractures.

KEY POINTS

• Our proposed weakly supervised method may have comparable or better performance than the supervised method for vertebral-level vertebral compression fracture classification. • The weakly supervised model could have classified cases with multiple vertebral compression fractures at the vertebral-level, even if the model was trained with image-level labels. • Our proposed method could help reduce radiologists' labour because it enables vertebral-level classification from image-level labels.

Posterolateral Instrumented Fusion in Elderly Patients With a Single Osteoporotic Vertebral Fracture: Evaluation of Health-Related Quality of Life

Introduction Treatment of osteoporotic vertebral fractures (OVFs) is a factor that affects the quality of life and should be considered during management. In patients with a single OVF and neurologic deficit, surgical procedures aiming at neural decompression with instrumented fusion should be considered in elderly individuals. Posterolateral instrumented fusion (PLF) constitutes a largely performed fusion surgery for patients featuring indications for fusion surgery. The aim of this study was to determine the safety, effectiveness, and impact on health-related quality of life (HRQoL) of PLF surgery in elderly patients diagnosed with a single OVF. Methods This study was conducted at Interbalkan European Medical Center, Thessaloniki, Greece. Eighty (80) consecutive individuals with OVFs were subjected to PLF and recruited in this prospectively designed non-randomized study. Clinical evaluation was performed preoperatively and postoperatively at particular chronic intervals at one, three, six, and 12 months and two years. The assessment was conducted via the standardized Visual Analogue Scale (VAS) and Short-Form 36 (SF-36) Medical Health Survey Questionnaire for pain and HRQoL, respectively. Results No major perioperative complications were observed. All parameters of SF-36 presented significant improvement over the entire follow-up period with VAS scores reaching a plateau at six months. Depicted improvement of these parameters proves the beneficial role of PLF in elderly patients who suffered from a single OVF with or without referable neurological deficit. Conclusion OVFs have a significant impact on the quality of life of elderly patients, and surgical treatment with PLF with or without decompression can lead to functional recovery, pain relief, and HRQoL amelioration. Our results demonstrated that the outcomes of PLF in the surgical treatment of these patients are remarkably favorable, demonstrating the safety and efficacy of the technique.

Time to revisit contraindications of vertebroplasty- A retrospective study of osteoporotic burst fracture operated with vertebroplasty and short segment fixation

Background

Methods

Results

Conclusions

Substantial Atrophy of the Psoas Muscle as Late Sequela of L2 Osteoporotic Fracture: a Case Report

Osteoporotic vertebral fractures (OVFs) are considered benign and heal after 8-12 weeks. Nevertheless, up to one third of these patients will have persistent back pain, which may be complicated with neurologic deficit or paraplegia A unique unusual case of delayed onset of neurological complication of an osteoporotic vertebral fracture (OVF) in an elderly patient is reported. The patient presented with paraparesis due to isolated substantial atrophy of the psoas muscle 12 months after the initial fracture. The patient was investigated with imaging and nerve contacted studies. We suggest that psoas muscle atrophy can be determinant clinical sign to diagnose neurological compromise resulting from OVF, even if there is no other clinical indicators of spinal pathology.

Osteoporotic burst fracture-clinical, radiological and functional outcome of three-column reconstruction using single posterior approach (Instrumentation, Corpectomy, Arthroscope Assisted Transpedicular Decompression and Mesh Cage)

PURPOSE

To evaluate a novel effective procedure utilizing three-column reconstruction via a posterior approach with a technique that utilizes an arthroscope to visualize the anterior surface of the dura during decompression.

METHODS

A Prospective Study. 80 Osteoporotic vertebral burst fracture patients with similar demographic data managed by three-column reconstruction through single posterior approach surgery: Pedicle screw fixation, Corpectomy, Arthroscope Assisted Transpedicular Decompression (AATD) and Fusion (Mesh Cage + Bone grafting). Preoperative and postoperative clinical parameters (Visual Analog Score VAS, swestry Disability Index ODI, neurlogy, radiological parameters and surgical variables were recorded analysed.

RESULTS

No significant differences in demographic data. Significant improvement was noted in VAS (pre-operative, 7.90 ±0.60; final follow-up 2.90 ± 0.54) and ODI (preoperative, 77.10 ± 6.96; final follow-up 21.30 ± 6.70). Neurological improvement was noted in 74 patients (Frankel grade E) while six patients remained non-ambulatory (Frankel grade C). Significant improvement was noted in local kyphosis angle (preoperative, 22.14 ± 2.60; postoperative, 10.40 ± 1.40) with a 10% loss of correction (2.5 ± 0.90) at final follow-up. Implant failure in two patients and proximal junctional failure in two patients managed with revision surgery. No iatrogenic dural or nerve injury.

CONCLUSIONS

Osteoporotic Burst fracture can be managed with single posterior surgery, three-column reconstruction with mesh cage. It provides a significant improvement in clinical, radiological and functional outcomes. The arthroscope can improve a surgeon's operative field and magnification thereby ensuring complete decompression without injuring the dura or spinal cord.

Current Concepts in the Management of Vertebral Compression Fractures

PURPOSE OF REVIEW

This comprehensive review of current concepts in the management of vertebral compression fractures is a manuscript of vertebral augmentation literature of risk factors, clinical presentation, and management. The objective of this review is to compare outcomes between multiple augmentation techniques and ongoing discussions of effectiveness of vertebral augmentation procedures.

RECENT FINDINGS

Vertebral compression fractures (VCFs) are a prevalent disease affecting approximately 1.5 million US adults annually. VCFs can cause severe physical limitations, including back pain, functional disability, and progressive kyphosis of the thoracic spine that ultimately results in decreased appetite, poor nutrition, impaired pulmonary function, and spinal cord compression with motor and sensory deficits. The deconditioning that affects patients with vertebral compression fractures leads to mortality at a far higher rate than age-matched controls. The management of vertebral compression fractures has been extensively discussed with opponents arguing in favor or restricting conservative management and against augmentation, while proponents argue in favor of augmentation. The literature is well established in reference to the effects on mortality when patients undergo treatment with vertebral augmentation; in over a million patients with vertebral compression fractures treated with vertebral augmentation as compared with patients treated with non-surgical management, the patients receiving augmentation performed well with a decrease in morbidity and mortality. Summary of the literature review shows that understanding the risk factors, appropriate clinical evaluation, and management strategies are crucial. Analysis of the evidence shows, based on level I and II studies, balloon kyphoplasty had significantly better and vertebroplasty tended to have better pain reduction compared with non-surgical management. In addition, balloon kyphoplasty tended to have better height restoration than vertebroplasty.

Factors Impacting Mortality in Geriatric Patients with Acute Spine Fractures: A 12-Year Study of 613 Patients in Singapore

Study Design

Retrospective database analysis.

Purpose

To identify risk factors that predict mortality following acute spine fractures in geriatric patients of Singapore.

Overview of Literature

Acute geriatric spinal fractures contribute significantly to local healthcare costs and hospital admissions. However, geriatric mortality following acute spine fractures is scarcely assessed in the Asian population.

Methods

Electronic records of 3,010 patients who presented to our hospital’s emergency department and who were subsequently admitted during 2004–2015 with alleged history of traumatic spine fractures were retrospectively reviewed, and 613 patients (mean age, 85.7±4.5 years; range, 80–101 years; men, 108; women, 505) were shortlisted. Mortality rates were reviewed up to 1 year after admission and multivariate analyses were performed to identify independent risk factors correlating with mortality.

Results

Women were more susceptible to spine fractures (82.4%), with falls (77.8%) being the most common mechanism of injury. Mortality rates were 6.0%, 8.2%, and 10.4% at 3, 6, and 12 months, respectively. The most common causes of death at all 3 time points were pneumonia and ischemic heart disease. Based on the multivariate analysis at 1-year follow-up, elderly women had a lower mortality rate compared to men (p<0.001); mortality rates increased by 6.3% (p=0.024) for every 1-year increase in the patient’s age; and patients with an American Spinal Injury Association (ASIA) score of A–C had a much higher mortality rate compared to those with an ASIA score of D–E (p<0.001).

Conclusions

An older age at presentation, male sex, and an ASIA score of A–C were identified as independent factors predicting increased mortality among geriatric patients who sustained acute spine fractures. The study findings highlight at-risk groups for acute spine fractures, thereby providing an opportunity to develop strategies to increase the life expectancy of these patients.