1
|
Tang M, Zhang G, Zeng F, Chang X, Fang Q, He M, Yin S. Paraspinal muscle parameters' predictive value for new vertebral compression fractures post-vertebral augmentation: Nomogram development and validation. Front Med (Lausanne) 2024; 11:1379078. [PMID: 38813387 PMCID: PMC11133621 DOI: 10.3389/fmed.2024.1379078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024] Open
Abstract
Objective Prior research underscores the significance of paraspinal muscles in maintaining spinal stability. This study aims to investigate the predictive value of paraspinal muscle parameters for the occurrence of new vertebral compression fractures (NVCF) following percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCF). Methods Retrospectively collected data from October 2019 to February 2021 (internal validation, n = 235) and March 2021 to November 2021 (external validation, n = 105) for patients with OVCF treated with PVP/PKP at our institution. They were randomly divided into training (188 cases) and validation groups (47 cases) at an 8:2 ratio. Lasso regression and multivariable logistic regression identified independent risk factors in the training set, and a Nomogram model was developed. Accuracy was assessed using receiver operating characteristic curves (ROC), calibration was evaluated with calibration curves and the Hosmer-Lemeshow test, and clinical utility was analyzed using decision curve analysis (DCA) and clinical impact curve (CIC). Results Surgical approach, spinal computed tomography (CT) values, and multifidus skeletal muscle index (SMI) are independent predictors of postoperative NVCF in OVCF patients. A Nomogram model, based on the identified predictors, was developed and uploaded online. Internal validation results showed area under the curve (AUC) values of 0.801, 0.664, and 0.832 for the training set, validation set, and external validation, respectively. Hosmer-Lemeshow goodness-of-fit tests (χ2 = 7.311-14.474, p = 0.070-0.504) and calibration curves indicated good consistency between observed and predicted values. DCA and CIC demonstrated clinical net benefit within risk thresholds of 0.06-0.84, 0.12-0.23, and 0.01-0.27. At specificity 1.00-0.80, the partial AUC (0.106) exceeded that at sensitivity 1.00-0.80 (0.062). Conclusion Compared to the spinal CT value, the multifidus SMI has certain potential in predicting the occurrence of NVCF. Additionally, the Nomogram model of this study has a greater negative predictive value.
Collapse
Affiliation(s)
- Ming Tang
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- The Fifth Clinical College of Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Guangdong Zhang
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Fanyi Zeng
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Xindong Chang
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Qingqing Fang
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Mingfei He
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Shiwu Yin
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- The Fifth Clinical College of Medicine, Anhui Medical University, Hefei, Anhui, China
| |
Collapse
|
2
|
Osterhoff G, Schenk P, Katscher S, Schnake KJ, Bäumlein M, Zimmermann V, Schmeiser G, Scherer MA, Müller M, Sprengel K, Liepold K, Schramm S, Baron C, Siekmann H, Schwarz F, Franck A, Scheyerer MJ, Spiegl UJA, Ullrich BW. Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Fractures With Anterior or Posterior Tension Band Failure (OF 5): Short-Term Results From the Prospective EOFTT Multicenter Study. Global Spine J 2023; 13:44S-51S. [PMID: 37084351 PMCID: PMC10177311 DOI: 10.1177/21925682221127956] [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] [Indexed: 04/23/2023] Open
Abstract
STUDY DESIGN Subgroup analysis of a multicenter prospective cohort study. OBJECTIVE To analyse surgical strategies applied to osteoporotic thoracolumbar osteoporotic fracture (OF) 5 injuries with anterior or posterior tension band failure and to assess related complications and clinical outcome. METHODS A multicenter prospective cohort study (EOFTT) was conducted at 17 spine centers including 518 consecutive patients who were treated for an osteoporotic vertebral fracture (OVF). For the present study, only patients with OF 5 fractures were analysed. Outcome parameters were complications, Visual Analogue Scale (VAS), Oswestry Disability Questionnaire (ODI), Timed Up & Go test (TUG), EQ-5D 5L, and Barthel Index. RESULTS In total, 19 patients (78 ± 7 years, 13 female) were analysed. Operative treatment consisted of long-segment posterior instrumentation in 9 cases and short-segment posterior instrumentation in 10 cases. Pedicle screws were augmented in 68 %, augmentation of the fractured vertebra was performed in 42%, and additional anterior reconstruction was done in 21 %. Two patients (11 %) received short-segment posterior instrumentation without either anterior reconstruction or cement-augmentation of the fractured vertebra. No surgical or major complications occurred, but general postoperative complications were observed in 45%. At a follow-up of mean 20 ± 10 weeks (range, 12 to 48 weeks), patients showed significant improvements in all functional outcome parameters. CONCLUSIONS In this analysis of patients with type OF 5 fractures, surgical stabilization was the treatment of choice and lead to significant short-term improvement in terms of functional outcome and quality of life despite a high general complication rate.
Collapse
Affiliation(s)
- Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Philipp Schenk
- Department of Science, Research and Education, BG Klinikum Bergmannstrost Halle, Germany
| | - Sebastian Katscher
- Interdisciplinary Center for Spine and Neurotrauma, Sana Klinikum Borna, Borna, Germany
| | - Klaus John Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Martin Bäumlein
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Volker Zimmermann
- Department of Trauma and Orthopedic Surgery, Klinikum Traunstein, Traunstein, Germany
| | - Gregor Schmeiser
- Department of Spine Surgery, Schoen-Klinik Hamburg-Eilbek, Hamburg, Germany
| | - Michael A Scherer
- Lehrkörper Medizinische Fakultät der Technischen Universität München (Med. Fak. TUM), Arabella-Klinik, Munich, Germany
| | - Michael Müller
- Department of Orthopedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Kai Sprengel
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Katja Liepold
- Department of Spine Surgery, Teaching Hospital of the University of Jena, Thuringia Clinic "Georgius Agricola" Saalfeld, Saalfeld, Germany
| | - Simon Schramm
- Department of Trauma Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Holger Siekmann
- Clinic of Trauma-, Hand- and Reconstruction Surgery, AMEOS-Clinic Halberstadt, Halberstadt, Germany
| | - Falko Schwarz
- Department of Neurosurgery, Friedrich Schiller University, Jena University Hospital, Jena, Germany
| | - Alexander Franck
- Department of Orthopaedics and Trauma Surgery, Regiomed Klinikum Coburg, Germany
| | - Max J Scheyerer
- Department of Orthopedics and Trauma Surgery, University Hospital, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Ulrich J A Spiegl
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Bernhard W Ullrich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Germany
| |
Collapse
|
3
|
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
|
4
|
Davidson S, Vecellio A, Flagstad I, Holton K, Bruzina A, Lender P, Trost S, Polly D. Discrepancy between DXA and CT-based assessment of spine bone mineral density. Spine Deform 2023; 11:677-683. [PMID: 36735159 DOI: 10.1007/s43390-023-00646-5] [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: 09/02/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Adequate bone mineral density (BMD) is necessary for success in spine surgery. Dual-energy X-ray absorptiometry (DXA) is the gold standard in determining BMD but may give spuriously high values. Hounsfield units (HU) from computed tomography (CT) may provide a more accurate depiction of the focal BMD encountered during spine surgery. Our objective is to determine the discrepancy rate between DXA and CT BMD determinations and how often DXA overestimates BMD compared to CT. METHODS We retrospectively reviewed 93 patients with both DXA and CT within 6 months. DXA lumbar spine and overall T scores were classified as osteoporotic (T Score ≤ - 2.5) or non-osteoporotic (T Score > -2.5). L1 vertebral body HU were classified as osteoporotic or non-osteoporotic using cutoff thresholds of either ≤ 135 HU or ≤ 110 HU. Corresponding DXA and HU classifications were compared to determine disagreement and overestimation rates. RESULTS Using lumbar T scores, the CT vs DXA disagreement rate was 40-54% depending on the HU threshold. DXA overestimated BMD 97-100% of the time compared to CT. Using overall DXA T scores, the disagreement rate was 33-47% with DXA greater than CT 74-87% of the time. In the sub-cohort of 10 patients with very low HU (HU < 80), DXA overestimated BMD compared to CT in every instance. CONCLUSIONS There is a large discrepancy between DXA and CT BMD determinations. DXA frequently overestimates regional BMD encountered during spine surgery compared with CT. While DXA remains the gold standard in determining BMD, CT may play an important role in defining the focal BMD pertinent to spine surgery.
Collapse
Affiliation(s)
- Samuel Davidson
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
| | - Alison Vecellio
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - Ilexa Flagstad
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - Kenneth Holton
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - Angela Bruzina
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - Paul Lender
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - Susanne Trost
- The Department of Medicine, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - David Polly
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.,The Department of Neurosurgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| |
Collapse
|
5
|
Duelfer K, Sakow C, Chang H, Boffeli T. Assessment of Bone Mineral Density in the Distal Tibia Using Quantitative Hounsfield Samples From Computer Tomography. J Foot Ankle Surg 2022; 62:120-124. [PMID: 35705456 DOI: 10.1053/j.jfas.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 02/03/2023]
Abstract
The distal tibia bone quality is of paramount importance for ankle fractures, total ankle implants, ankle fusions, and osteotomy procedures. Despite this fact relatively little is known regarding the overall bone quality for this section of the tibia. Previous literature suggest that there is a statistically significant decrease in bone mineral density within the distal 5% to 10% segment of the tibia medullary canal. This segment of medullary bone is considerable in size and thus valuable for fixation constructs as it is oftentimes utilized for medial malleolar fractures, distal tibia fractures, total ankle replacements, ankle fusions, and other procedures. This study assessed bone attenuation between the distal 5% and 10% mark of the tibia in 1% slices via Hounsfield unit measurements on CT scans based on previously established correlation between Hounsfield units and bone mineral density found on DEXA scans. One hundred five distal tibia segments were assessed with an average interval in percentile slices of 3.8 mm. As expected there was a gradual decrease in bone attenuation noted with each proximal percentile segment. There exists a statistically significant difference in bone attenuation among males versus females as well as those older than 60 years versus younger than 60 years. The findings suggest fixation constructs in the tibia medullary canal may find limited benefit proximal from 7% segment in females ≥60, or 26.1 mm from tibial plafond. Fixation constructs in tibia medullary canal may find limited benefit proximal from 8% segment in males <60, or 32.3 mm from tibial plafond.
Collapse
Affiliation(s)
- Keegan Duelfer
- Resident, Foot and Ankle Surgical Residency Program, Regions Hospital, Health Partners Institute for Education and Research, St. Paul, MN.
| | - Chloe Sakow
- Resident, Foot and Ankle Surgical Residency Program, Regions Hospital, Health Partners Institute for Education and Research, St. Paul, MN
| | - Howard Chang
- Resident, Foot and Ankle Surgical Residency Program, Regions Hospital, Health Partners Institute for Education and Research, St. Paul, MN
| | - Troy Boffeli
- Director, Foot and Ankle Surgical Residency Program, Regions Hospital, HealthPartners Institute for Education and Research, St. Paul, MN
| |
Collapse
|
6
|
Spiegl UJ, Behr L, Osterhoff G, Rupprecht G, Scheyerer MJ, Katscher S. OF spine classification of osteoporotic thoracolumbar vertebral body fractures by MRI and conventional radiographs only leads to high inter-observer agreement rates-an additional CT adds limited information for the of classification and the OF score. BMC Musculoskelet Disord 2022; 23:1086. [PMID: 36510215 PMCID: PMC9743708 DOI: 10.1186/s12891-022-06056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate whether the addition of computed tomography (CT) to magnetic resonance imaging (MRI) improves the accuracy of classifying osteoporotic vertebral body fractures (OVBF). METHODS A retrospective analysis of a prospective single-center database has been performed. All consecutive patients who had suffered an acute thoracolumbar OVBF in one level II spine center between 2017 and 2019 were analyzed. Thereby, fractures of type OF 1 and OF 5 were excluded. All fractures were initially classified by 5 board-certified orthopaedic surgeons based on MRI and conventional radiographs. Afterwards a reclassification including CT scans were performed. Differences in OF classification and OF score values between both measurements were analyzed. RESULTS A total of 61 patients were analyzed with a mean age 75.8 years (SD: 8.8 years). In 82.9% of the cases, there was no difference in OF classification comparing classification based only on MRI versus MRI + CT. A difference of more than two OF types was observed in less than 1% of all ratings. The inter-rater reliabilities of the OF classification based on CT + MRI and MRI alone were 0.63 and 0.49, respectively. In 97.5% of the cases there was no therapy-relevant difference of the treatment recommendation with respect of a surgical or nonoperative treatment recommendation based on the OF score. CONCLUSION In terms of the OF classification and the OF score, the addition of CT add limited value compared to conventional radiographs and MRI only. Additionally, there is only a minor rate of disagreement in treatment recommendations when adding a CT.
Collapse
Affiliation(s)
- Ulrich J. Spiegl
- grid.411339.d0000 0000 8517 9062Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Lars Behr
- Interdisciplinary Spine Center and Neurotraumatology, Sana Hospital Leipziger Land, Borna, Germany
| | - Georg Osterhoff
- grid.411339.d0000 0000 8517 9062Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Gunnar Rupprecht
- Interdisciplinary Spine Center and Neurotraumatology, Sana Hospital Leipziger Land, Borna, Germany
| | - Max J. Scheyerer
- grid.411327.20000 0001 2176 9917Department for Orthopaedic and Trauma Surgery, University of Düsseldorf, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Sebastian Katscher
- Interdisciplinary Spine Center and Neurotraumatology, Sana Hospital Leipziger Land, Borna, Germany
| |
Collapse
|
7
|
Insuffizienzfrakturen der Wirbelsäule in Abhängigkeit von der spongiösen Knochendichte. DIE ORTHOPÄDIE 2022; 51:547-555. [PMID: 35776151 PMCID: PMC9249701 DOI: 10.1007/s00132-022-04261-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/27/2022] [Indexed: 11/12/2022]
Abstract
Hintergrund Das Risiko für osteoporotische Insuffizienzfrakturen (Fx) am Achsenskelett steigt mit zunehmender Abnahme der Knochendichte, wobei sich thorakal und thorakolumbal eine Häufung findet. Um die unterschiedliche Verteilung von Fx entlang der Wirbelsäule (WS) besser zu verstehen, wurden morphologische und osteodensitometrische Untersuchungen mittels Computertomographie (CT) in den verschiedenen WS-Abschnitten durchgeführt. Zudem war zu klären, ob die bei CT-Untersuchungen aus anderen Indikationen gefunden Hounsfield-Einheiten (HE) mit der Knochendichte korrelieren und Anlass für eine osteologische Diagnostik sein könnten. Material und Methoden Von 26 Körperspenden wurden die gesamten WS in einem Plexiglas-Wasser-Phantom fixiert und mittels hochauflösende Spiral-CT analysiert. Zusätzlich erfolgte die Messung der CT-morphologischen Spongiosadichte in HE von C3 bis S2 (624 Wirbelkörper). Der Knochenmineralgehalt (KMG, mg/ml) wurde ermittelt und zur Abschätzung einer Osteoporose (OPO) herangezogen. Ergebnisse Bei allen WS lag eine OPO vor. Bei einem KMG unterhalb von 60 mg/ml fanden sich signifikant vermehrte Sinterungsfrakturen im thorakalen und thorakolumbalen Bereich. Osteoporotische Insuffizienzfrakturen im HWS-Bereich fanden sich insgesamt nicht. Die Spongiosadichte war signifikant höher in den zervikalen (Median 188,6 HE) als in den lumbalen (Median 63,6 HE) und sakralen (Median 25,5 HE) Wirbelkörpern aller untersuchten WS. Schlussfolgerung Ein KMG-Verlust der Wirbelkörperspongiosa führt zu einem erhöhten Fx-Risiko, welches sich auch bei den verwendeten WS findet. Jedoch wird im zervikalen Bereich ein scheinbarer Schwellenwert für das Auftreten von Sinterungsfrakturen nicht unterschritten. Einen Schwellenwert für HE zu finden, wäre für die klinische Praxis relevant.
Collapse
|
8
|
Marques ML, Pereira da Silva N, van der Heijde D, Reijnierse M, Baraliakos X, Braun J, van Gaalen FA, Ramiro S. Low-dose CT hounsfield units: a reliable methodology for assessing vertebral bone density in radiographic axial spondyloarthritis. RMD Open 2022; 8:rmdopen-2021-002149. [PMID: 35732346 PMCID: PMC9226987 DOI: 10.1136/rmdopen-2021-002149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Studying vertebral bone loss in radiographic axial spondyloarthritis (r-axSpA) has been challenging due to ectopic bone formation. We cross-sectionally analysed low-dose CT (ldCT) trabecular bone density Hounsfield units (HU) measurements and calculated inter-reader reliability at the vertebral level in patients with r-axSpA. Methods LdCT scans of 50 patients with r-axSpA from the sensitive imaging in ankylosing spondylitis study, a multicentre 2-year prospective cohort were included. Trabecular bone HU taken from a region of interest at the centre of each vertebra (C3-L5) were independently assessed by two trained readers. HU mean (SD), and range were provided at the vertebral level, for each reader and centre separately. Inter-reader reliability and agreement were assessed using intraclass correlation coefficients (ICC; single measurements, absolute agreement, two-way mixed effects models); smallest detectable difference and Bland-Altman plots. Results Overall, 1100 vertebrae were assessed by each reader. HU values decreased from cranial to caudal vertebrae. For readers 1 and 2 respectively, the highest mean (SD) HU value was obtained at C3 (354(106) and 355(108)), and the lowest at L3 (153(65) and 150 (65)). Inter-reader reliability was excellent (ICC(2,1):0.89 to 1.00). SDD varied from 4 to 8. For most vertebrae, reader 1 scored somewhat higher than reader 2 (mean difference of scores ranging from −0.6 to 2.9 HU). Bland-Altman plots showed homoscedasticity. Conclusion LdCT measurement of HU is a feasible method to assess vertebral bone density in r-axSpA with excellent inter-reader reliability from C3 to L5. These results warrant further validation and longitudinal assessment of reliability.
Collapse
Affiliation(s)
- Mary Lucy Marques
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands .,Department of Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Nuno Pereira da Silva
- Department of Radiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Juergen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Bochum, Germany
| | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| |
Collapse
|
9
|
Osterhoff G, Asatryan G, Spiegl UJA, Pfeifle C, Jarvers JS, Heyde CE. Impact of Multifidus Muscle Atrophy on the Occurrence of Secondary Symptomatic Adjacent Osteoporotic Vertebral Compression Fractures. Calcif Tissue Int 2022; 110:421-427. [PMID: 34654940 PMCID: PMC8927004 DOI: 10.1007/s00223-021-00925-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/08/2021] [Indexed: 10/28/2022]
Abstract
To assess the potential influence of multifidus atrophy and fatty degeneration on the incidence of adjacent vertebral compression fractures within one year after the index fracture. In a retrospective cohort study, patients who underwent surgery for an OVCF were identified and baseline characteristics, fracture patterns and the occurrence of secondary adjacent fractures within one year were obtained by chart review. Multifidus muscle atrophy and fatty degeneration were determined on preoperative MRI or CT scans. In this analysis of 191 patients (mean age 77 years, SD 8, 116 female), OF type 3 was the most common type of OVCF (49.2%). Symptomatic adjacent OVCFs within one year after index fracture were observed in 23/191 patients (12%) at mean 12, SD 12 weeks (range 1-42 weeks) postoperatively. The mean multifidus muscle area was 264, SD 53 mm2 in patients with an adjacent vertebral fracture and 271, SD 92 mm2 in patients without a secondary fracture (p = 0.755). Mean multifidus fatty infiltration was graded Goutallier 2.2, SD 0.6 in patients with an adjacent fracture and Goutallier 2.2, SD 0.7 in patients without an adjacent fracture (p = 0.694). Pre-existing medication with corticosteroids was associated with the occurrence of an adjacent fracture (p = 0.006). Multifidus area and multifidus fatty infiltration had no significant effect on the occurrence of adjacent vertebral fractures within one year after the index fracture. Patients with a pre-existing medication with corticosteroids were more likely to sustain an adjacent fracture.
Collapse
Affiliation(s)
- Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany.
| | - Garnik Asatryan
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Ulrich J A Spiegl
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Christian Pfeifle
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Jan-Sven Jarvers
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Christoph-E Heyde
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| |
Collapse
|
10
|
The influence of bone quality on radiological outcome in 50 consecutive acetabular fractures treated with a pre-contoured anatomic suprapectineal plate. Arch Orthop Trauma Surg 2022; 142:1539-1546. [PMID: 33760940 PMCID: PMC9217777 DOI: 10.1007/s00402-021-03867-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the range of indications of an anatomical-preshaped three-dimensional suprapectineal plate and to assess the impact of the bone mass density on radiologic outcomes in different types of acetabular fractures. PATIENTS AND METHODS A consecutive case series of 50 acetabular fractures (patient age 69 ± 23 years) treated with suprapectineal anatomic plates were analyzed in a retrospective study. The analysis included: Mechanism of injury, fracture pattern, surgical approach, need for additional total hip arthroplasty, intra- or postoperative complications, as well as bone mass density and radiological outcome on postoperative computed tomography. RESULTS Most frequently, anterior column fracture patterns with and without hemitransverse components as well as associated two column fractures were encountered. The anterior intrapelvic approach (AIP) was used in 98% (49/50) of the cases as primary approach with additional utilization of the first window of the ilioinguinal approach in 13/50 cases (26%). Determination of bone density revealed impaired bone quality in 70% (31/44). Postoperative steps and gaps were significantly greater in this subgroup (p < 0.05). Fracture reduction quality for postoperative steps revealed anatomic results in 92% if the bone quality was normal and in 46% if impaired (p < 0.05). In seven cases (14%), the plate was utilized in combination with acute primary arthroplasty. CONCLUSION A preshaped suprapectineal plate provides good radiological outcomes in a variety of indications in a predominantly geriatric cohort. Impaired bone quality has a significantly higher risk of poor reduction results. In cases with extensive joint destruction, the combination with total hip arthroplasty was a valuable option.
Collapse
|
11
|
How relevant is lumbar bone mineral density for the stability of symphyseal implants? A biomechanical cadaver study. Eur J Trauma Emerg Surg 2021; 48:3101-3108. [PMID: 34881391 PMCID: PMC9360150 DOI: 10.1007/s00068-021-01850-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Osteoporotic bone tissue appears to be an important risk factor for implant loosening, compromising the stability of surgical implants. However, it is unclear whether lumbar measured bone mineral density (BMD) is of any predictive value for stability of surgical implants at the pubic symphysis. This study examines the fixation strength of cortical screws in human cadaver specimens with different BMDs. METHODS The lumbar BMD of ten human specimens was measured using quantitative computed tomography (qCT). A cut-off BMD was set at 120 mg Ca-Ha/mL, dividing the specimens into two groups. One cortical screw was drilled into each superior pubic ramus. The screw was withdrawn in an axial direction with a steady speed and considered failed when a force decrease was detected. Required force (N) and pull-out distance (mm) were constantly tracked. RESULTS The median peak force of group 1 was 231.88 N and 228.08 N in group 2. While BMD values differed significantly (p < 0.01), a comparison of peak forces between both groups showed no significant difference (p = 0.481). CONCLUSION Higher lumbar BMD did not result in significantly higher pull-out forces at the symphysis. The high proportion of cortical bone near the symphyseal joint allows an increased contact of pubic screws and could explain sufficient fixation. This condition is not reflected by a compromised lumbar BMD in a qCT scan. Therefore, site-specific BMD measurement could improve individual fracture management.
Collapse
|
12
|
Omar Pacha T, Ghasemi A, Omar M, Graulich T, Krettek C, Weng YW, Stubig T. Possible Correlation Between Kyphosis of Lumbar Osteoporosis Fractures and the Spinal Signal Intensity Ratio (SSIR). Int J Spine Surg 2021; 15:478-484. [PMID: 33963021 DOI: 10.14444/8069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the correlation between the risk of increasing kyphosis as well as collapse of the osteoporotic vertebral body fractures and the intensity of the bone edema in magnetic resonance imaging (MRI) scans. Inclusion criteria included the following: age >18 years and osteoporotic vertebral body fracture grade I-IV according to OF classification. Exclusion criteria included the following: other pathological fractures due to primary tumors or metastasis, OF grade V fractures, and AO type B or C fractures. METHODS This was a retrospective study from pseudonymized data of a tertiary spine center. No additional imaging were performed. Measurements of bisegmental kyphosis angle of the fracture for involvement of both endplates and monosegmental angle for involvement of 1 endplate, as well as vertebral body height loss in initial radiographs and at follow-ups after 3 and 6 months have been performed. Also, the initial signal intensity of the vertebral body edema was measured using integrated tool of the DICOM viewer (Impax V6.5 Agfa, Brentford, UK) in addition to the signal intensity of the cerebrospinal fluid (CSF) as reference for T1, T2, and separate target illumination radar (STIR) sequences of the MRI scans. A quotient from the signal intensity of the vertebral body edema and the reference (CSF) has been generated. Patients have been divided to 4 groups according to the ratio (<1, 1-2, 2-3, >3) and compared in regards to the results of the degree of kyphosis and vertebral collapse at follow-ups and final examination. The statistical analysis was performed using linear regression using statistic software SPSS version 26. RESULTS AND CONCLUSIONS Forty-four patients have been included: 9 males and 35 females with an average age of 71.5 years. The analysis showed a significant correlation between the increasing kyphosis at follow-ups and the quotient of the signal intensity for STIR and T2 weighing with P = .002 (SD ±2.664) for STIR and P = .001 (SD ±1.616) for T2 sequences. Furthermore, there was only a correlation between the intensity ratio and kyphosis for STIR weighting at last examination (P = .017; SD ±1.360). There was no correlation between the height loss and the signal intensity. LEVEL OF EVIDENCE Level 2.
Collapse
Affiliation(s)
- Tarek Omar Pacha
- Trauma Department, Hannover Medical School (MHH), Lower Saxony, Germany
| | - Amir Ghasemi
- Center for Spinal studies and Surgery, Nottingham University Hospital, United Kingdom
| | - Mohamed Omar
- Trauma Department, Hannover Medical School (MHH), Lower Saxony, Germany
| | - Tilman Graulich
- Trauma Department, Hannover Medical School (MHH), Lower Saxony, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School (MHH), Lower Saxony, Germany
| | - Yoon Wai Weng
- Center for Spinal studies and Surgery, Nottingham University Hospital, United Kingdom
| | - Timo Stubig
- Trauma Department, Hannover Medical School (MHH), Lower Saxony, Germany
| |
Collapse
|
13
|
Vordemvenne T, Wähnert D, Klingebiel S, Lohmaier J, Hartensuer R, Raschke MJ, Roßlenbroich S. Differentiation of Traumatic Osteoporotic and Non-Osteoporotic Vertebral AO A3 Fractures by Analyzing the Posterior Edge Morphology-A Retrospective Feasibility Study. J Clin Med 2020; 9:jcm9123910. [PMID: 33276462 PMCID: PMC7760871 DOI: 10.3390/jcm9123910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Differentiation between traumatic osteoporotic and non-osteoporotic vertebral fractures is crucial for optimal therapy planning. We postulated that the morphology of the posterior edge of the cranial fragment of A3 vertebral fractures is different in these entities. Therefore, the purpose of this study is to develop and validate a simple method to differentiate between osteoporotic and non-osteoporotic A3 vertebral fractures by morphological analysis. METHODS A total of 86 computer tomography scans of AO Type A3 (cranial burst) vertebral body fractures (52 non-osteoporotic, 34 osteoporotic) were included in this retrospective study. Posterior edge morphology was analyzed using the sagittal paramedian slice with the most prominent shaped bulging. Later, the degree of bulging of the posterior edge fragment was quantified using a geometric approach. Additionally, the Hounsfield units of the broken vertebral body, the vertebra above, and the vertebra below the fracture were measured. RESULTS We found significant differences in the extent of bulging comparing osteoporotic and non-osteoporotic fractures in our cohort. Using the presented method, sensitivity was 100%, specificity was 96%. The positive predictive value (PPV) was 94%. In contrast, by evaluating the Hounsfield units, sensitivity was 94%, specificity 94% and the PPV was 91%. CONCLUSIONS Our method of analysis of the bulging of the dorsal edge fragment in traumatic cranial burst fractures cases allows, in our cases, a simple and valid differentiation between osteoporotic and non-osteoporotic fractures. Further validation in a larger sample, including dual-energy X-ray absorptiometry (DXA) measurements, is necessary.
Collapse
Affiliation(s)
- Thomas Vordemvenne
- Department of Trauma and Orthopedic Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, Burgsteig 13, 33617 Bielefeld, Germany; (D.W.); (J.L.)
- Correspondence: ; Tel.: +49-(0)521-772-77418
| | - Dirk Wähnert
- Department of Trauma and Orthopedic Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, Burgsteig 13, 33617 Bielefeld, Germany; (D.W.); (J.L.)
| | - Sebastian Klingebiel
- Department of Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany;
| | - Jens Lohmaier
- Department of Trauma and Orthopedic Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL of Bielefeld University, Campus Bielefeld-Bethel, Burgsteig 13, 33617 Bielefeld, Germany; (D.W.); (J.L.)
| | - René Hartensuer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany; (R.H.); (M.J.R.); (S.R.)
| | - Michael J. Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany; (R.H.); (M.J.R.); (S.R.)
| | - Steffen Roßlenbroich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany; (R.H.); (M.J.R.); (S.R.)
| |
Collapse
|
14
|
Schnake KJ, Scheyerer MJ, Spiegl UJA, Perl M, Ullrich BW, Grüninger S, Osterhoff G, Katscher S, Sprengel K. [Minimally invasive stabilization of thoracolumbar osteoporotic fractures]. Unfallchirurg 2020; 123:764-773. [PMID: 32613278 DOI: 10.1007/s00113-020-00835-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Minimally invasive stabilization of thoracolumbar osteoporotic fractures (OF) in neurologically intact patients is well established. Various posterior and anterior surgical techniques are available. The OF classification and OF score are helpful for defining the indications and choice of operative technique. OBJECTIVE This article gives an overview of the minimally invasive stabilization techniques, typical complications and outcome. MATERIAL AND METHODS Selective literature search and description of surgical techniques and outcome. RESULTS Vertebral body augmentation alone can be indicated in painful but stable fractures of types OF 1 and OF 2 and to some extent for type OF 3. Kyphoplasty has proven to be an effective and safe procedure with a favorable clinical outcome. Unstable fractures and kyphotic deformities (types OF 3-5) should be percutaneously stabilized from posterior. The length of the pedicle screw construct depends on the extent of instability and deformity. Bone cement augmentation of the pedicle screws is indicated in severe osteoporosis but increases the complication rate. Restoration of stability of the anterior column can be achieved through additional vertebral body augmentation or rarely by anterior stabilization. Clinical and radiological short and mid-term results of the stabilization techniques are promising; however, the more invasive the surgery, the more complications occur. CONCLUSION Minimally invasive stabilization techniques are safe and effective. The specific indications for the individual procedures are guided by the OF classification and the individual clinical situation of the patient.
Collapse
Affiliation(s)
- Klaus John Schnake
- Zentrum für Wirbelsäulen- und Skoliosetherapie, Malteser Waldkrankenhaus St. Marien, Rathsberger Str. 57, 91054, Erlangen, Deutschland.
| | - Max Josef Scheyerer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Merseburger Str. 165, 06112, Halle, Deutschland
| | - Ulrich Josef Albert Spiegl
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Mario Perl
- Unfallchirurgische Klinik - Orthopädische Chirurgie, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Krankenhausstr. 12, 91054, Erlangen, Deutschland
| | - Bernhard Wilhelm Ullrich
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Merseburger Str. 165, 06112, Halle, Deutschland
| | - Sebastian Grüninger
- Universitätsklinik für Orthopädie und Unfallchirurgie, Paracelsus Medizinische Privatuniversität, Klinikum Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland
| | - Georg Osterhoff
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Sebastian Katscher
- Interdisziplinäres Wirbelsäulenzentrum und Neurotraumatologie, Sana Kliniken Leipziger Land GmbH, Klinikum Borna, Rudolf-Virchow-Str. 2, 04552, Borna, Deutschland
| | - Kai Sprengel
- Klinik für Traumatologie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Schweiz
| | | |
Collapse
|
15
|
Modified therapy concepts for fragility fractures of the pelvis after additional MRI. PLoS One 2020; 15:e0238773. [PMID: 33031459 PMCID: PMC7544090 DOI: 10.1371/journal.pone.0238773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fractures of the pelvic ring in elderly patients have increased in frequency over time. These injuries are associated with a high morbidity and have a socio-economic impact. The diagnostic procedures and their influence of therapy decisions are still controversial. METHODS In a retrospective study, we investigate the value of additional MRI examination on therapy decision of fragility fractures of the pelvis. The evaluation of all patients with pelvic fractures without adequate trauma and with performed CT and MRI was conducted at three large German hospitals. The imaging procedure took place within a maximum interval of 4 weeks. After evaluation of the imaging, the resulting therapeutic consequences either based on CT alone or on CT and MRI were reviewed by experienced pelvic surgeons. RESULTS Of 754 patients with pelvic injuries, 67 (age 80 +/- 9.7 years, f: m 54:13) could be included. The detection of vertical fractures in CT (n = 40 unilateral, n = 11 bilateral) could be increased by the additional MRI (n = 44 unilateral, n = 23 bilateral). A horizontal fracture component was identified in CT in 9.0% (n = 6) vs. MRI in 25.4% (n = 17) of the cases. An anterior pelvic ring injury was detected in 71.6% (n = 44; 4x bilateral) in CT, in 80.6% in MRI (n = 50, 4 bilateral). Additive MRI imaging increased the decision rate for surgical therapy from 20.9% (n = 14) to 31.3% (n = 21). CONCLUSIONS The results of this study further support the value of bone marrow edema detection by MRI diagnostics (or dual source CT which showed promising initial results) for the detection of pelvic ring fractures. For the first time, the study identifies an additional therapeutic consequence by an increased rate of surgical procedures.
Collapse
|