Impact of Multifidus Muscle Atrophy on the Occurrence of Secondary Symptomatic Adjacent Osteoporotic Vertebral Compression Fractures

Risk factor analysis of adjacent vertebral compression fracture following the surgery of percutaneous kyphoplasty in postmenopausal women

To evaluate the risk factors for adjacent vertebral compression fracture(AVCF) following the surgery of percutaneous kyphoplasty (PKP) in postmenopausal women. Two hundred and ninety-seven postmenopausal female patients had been reviewed, underwent PKP surgery between January 2016 and December 2020, were divided into two groups according to whether or not AVCF. Receiver operating characteristic (ROC) curves were generated to analyze the sensitivity and specificity of the relative risk factors in the identification of AVCF. In this study of 297 postmenopausal women who underwent PKP, 67 developed AVCF during follow-up. There were no significant differences in BMI, surgical method, or cement leakage between the groups. The AVCF group was older, had lower BMD, less bone cement volume per section, higher VHA, and larger VKAC. The non-fracture group had lower postoperative VAS and fewer surgical vertebrae. The model showed good discrimination with age, BMD, postoperative VAS, VHR, and VKAC. ROC analysis indicated that a postoperative with high VHR, high VKAC or VAS score > 2.5 was highly predictive of AVCF in postmenopausal women after PKP. In the context of PKP for OVCF in postmenopausal women, it is crucial to avoid excessive VHR and VKAC. Postoperatively, clinicians should prioritize pain management strategies to ensure optimal patient outcomes.

Risk factors for secondary vertebral compression fracture after percutaneous vertebral augmentation: a single-centre retrospective study

OBJECTIVE

To determine the incidence of secondary vertebral compression fracture (SVCF) after percutaneous vertebral augmentation (PVA) and its correlative risk factors, and to provide theoretical evidence for clinical practice.

METHODS

A retrospective analysis of 288 cases of PVA completed in our hospital from June 2020 to June 2023 was performed, and the patients were divided into the non-secondary vertebral compression fracture group (N-SVCF group) and the secondary vertebral compression fracture group (SVCF group) according to whether SVCF occurred during the postoperative follow-up review. Gender, age, body mass index (BMI), T value of bone mineral density (BMD-T), underlying diseases (hypertension, diabetes mellitus, coronary heart disease, chronic obstructive pulmonary disease), intravertebral vacuum cleft (IVC), amount of bone cement injected, classification of cement diffusion, anterior vertebral recovery ratio, local Cobb angle correction rate, leakage of bone cement into the intervertebral space, and fat infiltration rate (FIR) of paraspinal muscles were collected from the patients. The incidence and risk factors of SVCF after PVA were evaluated using univariate and multivariate logistic regression analysis, and the predictive value of the independent risk factors was evaluated using receiver operating characteristic curve (ROC) to determine the cut-off points at which they were meaningful for the development of SVCF.

RESULTS

In our study, the incidence of SVCF was 14.60% (42/288) in 288 patients who underwent PVA. Univariate analysis showed that age, BMI, fat infiltration rate of paraspinal muscles, cement leakage into the intervertebral space, unilateral/bilateral pedicle puncture approach and presence of IVC were statistically different between N-SVCF and SVCF (P < 0.05). Multifactorial regression analysis and ROC regression analysis revealed that the fat infiltration rate of the psoas major and erector spinae muscles, cement leakage into the intervertebral space, and IVC (P < 0.05) were risk factors for the incident of SVCF after PVA (P < 0.05). Psoas major (FIR) more than 5.490% and erector spinae (FIR) more than 52.413% had a high possibility of the occurrence of SVCF after PVA.

CONCLUSION

In this study, logistic regression combined with ROC curve analysis indicated that FIR of psoas major and erector spinae, cement leakage in the intervertebral space, and IVC were risk factors for the occurrence of SVCF after PVA. Psoas major (FIR) more than 5.490% and erector spinae (FIR) more than 52.413% had a high possibility of the occurrence of SVCF after PVA.

Establishment of a risk prediction model for residual low back pain in thoracolumbar osteoporotic vertebral compression fractures after percutaneous kyphoplasty

OBJECTIVE

This study aims to identify potential independent risk factors for residual low back pain (LBP) in patients with thoracolumbar osteoporotic vertebral compression fractures (OVCFs) following percutaneous kyphoplasty (PKP) treatment. Additionally, we aim to develop a nomogram that can accurately predict the occurrence of residual LBP.

METHODS

We conducted a retrospective review of the medical records of thoracolumbar OVCFs patients who underwent PKP treatment at our hospital between July 2021 and December 2022. Residual LBP was defined as the presence of moderate or greater pain (VAS score ≥ 4) in the low back one day after surgery, and patients were divided into two groups: the LBP group and the non-LBP group. These patients were then randomly allocated to either a training or a validation set in the ratio of 7:3. To identify potential risk factors for residual LBP, we employed lasso regression for multivariate analysis, and from this, we constructed a nomogram. Subsequently, the predictive accuracy and practical clinical application of the nomogram were evaluated through a receiver operating characteristic (ROC) curve, a calibration curve, and a decision curve analysis (DCA).

RESULTS

Our predictive model revealed that five variables-posterior fascial oedema, intravertebral vacuum cleft, time from fracture to surgery, sarcopenia, and interspinous ligament degeneration-were correlated with the presence of residual LBP. In the training set, the area under the ROC was 0.844 (95% CI 0.772-0.917), and in the validation set, it was 0.842 (95% CI 0.744-0.940), indicating that the model demonstrated strong discriminative performance. Furthermore, the predictions closely matched actual observations in both the training and validation sets. The decision curve analysis (DCA) curve suggested that the model provides a substantial net clinical benefit.

CONCLUSIONS

We have created a novel numerical model capable of accurately predicting the potential risk factors associated with the occurrence of residual LBP following PKP in thoracolumbar OVCFs patients. This model serves as a valuable tool for guiding specific clinical decisions for patients with OVCFs.

[Osteoporotic vertebral body fractures]

The number of osteoporotic fractures of the spine is increasing. These fractures are associated with elevated morbidity and mortality. This article provides an overview of the special features of these fractures, the diagnostic procedure, their classification, and the conservative and surgical treatment options. For the mostly elderly patients, it is important to treat the underlying disease and to address associated problems such as frailty and sarcopenia. To meet this growing medical and socio-economic challenge, a holistic interdisciplinary and interprofessional treatment approach is required.

Association between circHIPK3/miR-378a-3p/HDAC4 axis and osteoporotic fractures: A comprehensive investigation

BACKGROUND

Osteoporotic fractures (OFs) are a significant public health issue, which can lead to pain and impaired mobility. The underlying mechanisms of OFs remain unclear, but recent studies have suggested that the circRNA-miRNA-mRNA pathway may play a crucial role.

PURPOSE

This study aimed to investigate the potential involvement of the circHIPK3/miR-378a-3p/HDAC4 pathway in the pathogenesis of OFs.

METHODS

We collected tissue and serum samples from 10 patients with OFs and 10 healthy controls. The expression levels of circHIPK3, miR-378a-3p, and HDAC4 were measured by qPCR and WB. Additionally, we quantified the serum levels of bone metabolism-related indicators (ALP, OC, TRAP, OCIF, ODF) using ELISA.

RESULTS

Our results revealed significant upregulation of circHIPK3 and HDAC4 in both tissue and serum samples from OF patients compared with controls. Simultaneously, we detected a lower expression level of miR-378a-3p in OF tissues and serum than that in the control group. Furthermore, the serum levels of bone metabolism-related indicators ALP, TRAP, OCIF, and ODF were significantly higher in OF patients than in the control group. Interestingly, the serum level of OCIF was lower in OF patients than in the control group.

CONCLUSION

Our study provides important evidence for the involvement of the circHIPK3/miR-378a-3p/HDAC4 pathway in the pathogenesis of OFs. The upregulation of circHIPK3 and HDAC4 and downregulation of miR-378a-3p observed in OF patients suggests their potential regulatory effects on bone metabolism. Meanwhile, abnormal expression of serum bone metabolism-related indicators may contribute to the development of OFs by disrupting the balance of bone remodeling.

Comparison Between the Clinical Effect of Percutaneous Kyphoplasty for Osteoporosis Vertebral Compression Fracture Patient with or Without Sarcopenia: A Retrospective Cohort Study

Background

Sarcopenia and osteoporosis vertebral compression fractures (OVCF) are common diseases that increase with age. This study aimed to investigate the effects of sarcopenia on OVCF patients after percutaneous kyphoplasty (PKP).

Methods

Data of 101 patients who were treated with single-level PKP between January 2021 and March 2022 at Ningbo No.6 Hospital were enrolled. Forty-five OVCF patients with sarcopenia who met our inclusion criteria were included in the Sarcopenia-PKP group (SPKP group), and 56 patients in the Normal-PKP group (NPKP group). All clinical and radiological data were collected from medical records. Baseline characteristics, operation-related parameters (operation time, time to ambulation, hospital stay, surgery segment), clinical outcomes (visual analog score [VAS], Oswestry Disability Index [ODI], Japanese Orthopaedic Association Scores [JOA] of lumber), radiological outcomes (vertebral anterior height rate and local kyphosis angle), Macnab score, and complications were evaluated and compared.

Results

There were no significant differences in age, sex, surgical segment preoperative VAS score, ODI, or JOA between the two groups (P > 0.05). The SPKP group had a significantly lower body mass index (BMI), bone mineral density (BMD), and smooth muscle index (SMI) than the NPKP group (P < 0.05). Significantly longer hospital stays and time to ambulation in SPKP group than NPKP group (3.7±0.8 vs 3.4±0.5 and 2.0±0.8 vs 1.6±0.5, P < 0.05). In SPKP group, significantly better clinical outcomes at 6- and 12-months follow-up were observed in NPKP group than SPKP group (P < 0.05), and NPKP group showed significantly better in vertebral anterior height rates than SPKP group after 6-month follow-up (P < 0.05). Moreover, there were significantly more cases of complications in the SPKP group (P < 0.05).

Conclusion

Sarcopenia could reduce the clinical effect of percutaneous kyphoplasty, and furthermore. Related studies are needed to verify the effect of sarcopenia on OVCF patients.

Fatty infiltration of the multifidus muscle independently increases osteoporotic vertebral compression fracture risk

BACKGROUND

Vertebral compression fractures decrease daily life activities and increase economic and social burdens. Aging decreases bone mineral density (BMD), which increases the incidence of osteoporotic vertebral compression fractures (OVCFs). However, factors other than BMD can affect OVCFs. Sarcopenia has been a noticeable factor in the aging health problem. Sarcopenia, which involves a decrease in the quality of the back muscles, influences OVCFs. Therefore, this study aimed to evaluate the influence of the quality of the multifidus muscle on OVCFs.

METHODS

We retrospectively studied patients aged 60 years and older who underwent concomitant lumbar MRI and BMD in the university hospital database, with no history of structurally affecting the lumbar spine. We first divided the recruited people into a control group and a fracture group according to the presence or absence of OVCFs, and further divided the fracture group into an osteoporosis BMD group and an osteopenia BMD group based on the BMD T-score of -2.5. Using images of lumbar spine MRI, the cross-sectional area and percentage of muscle fiber (PMF) of the multifidus muscle were obtained.

RESULTS

We included 120 patients who had visited the university hospital, with 45 participants in the control group and 75 in the fracture group (osteopenia BMD: 41, osteoporosis BMD: 34). Age, BMD, and the psoas index significantly differed between the control and fracture groups. The mean cross-sectional area (CSA) of multifidus muscles measured at L4-5 and L5-S1, respectively, did not differ among the control, P-BMD, and O-BMD groups. On the other hand, the PMF measured at L4-5 and L5-S1 showed a significant difference among the three groups, and the value of the fracture group was lower than that of the control group. Logistic regression analysis showed that the PMF value, not the CSA, of the multifidus muscle at L4-5 and L5-S1 affected the risk of OVCFs, with and without adjusting for other significant factors.

CONCLUSIONS

High percentage of fatty infiltration of the multifidus muscle increases the spinal fracture risk. Therefore, preserving the quality of the spinal muscle and bone density is essential for preventing OVCFs.

Associations between paraspinal muscles fatty infiltration and lumbar vertebral bone mineral density - An investigation by fast kVp switching dual-energy CT and QCT

Purpose

To investigate the relationship between paraspinal muscles fat content and lumbar bone mineral density (BMD).

Methods

A total of 119 participants were enrolled in our study (60 males, age: 50.88 ± 17.79 years, BMI: 22.80 ± 3.80 kg·m^-2; 59 females, age: 49.41 ± 17.69 years, BMI: 22.22 ± 3.12 kg·m^-2). Fat content of paraspinal muscles (erector spinae (ES), multifidus (MS), and psoas (PS)) were measured at (ES L1/2-L4/5; MS L2/3-L5/S1; PS L2/3-L5/S1) levels using dual-energy computed tomography (DECT). Quantitative computed tomography (QCT) was used to assess BMD of L1 and L2. Linear regression analysis was used to assess the relationship between BMD of the lumbar spine and paraspinal muscles fat content with age, sex, and BMI. The variance inflation factor (VIF) was used to detect the degree of multicollinearity among the variables. P < .05 was considered to indicate a statistically significant difference.

Results

The paraspinal muscles fat content had a fairly significant inverse association with lumbar BMD after controlling for age, sex, and BMI (adjusted R ² = 0.584-0.630, all P < .05).

Conclusion

Paraspinal muscles fat content was negatively associated with BMD.Paraspinal muscles fatty infiltration may be considered as a potential marker to identify BMD loss.

Three-Dimensional Reconstruction of a CT Image under Deep Learning Algorithm to Evaluate the Application of Percutaneous Kyphoplasty in Osteoporotic Thoracolumbar Compression Fractures

In order to investigate the therapeutic evaluation of percutaneous kyphoplasty (PKP) for the treatment of osteoporotic thoracolumbar compression fractures by three-dimensional (3D) reconstruction of computed tomography (CT) based on the deep learning V-Net network, the traditional V-Net was optimized first and a new and improved V-Net was proposed. The introduced U-Net, V-Net, and convolutional neural network (CNN) were compared in this study. Then, 106 patients with osteoporotic thoracolumbar compression fractures were enrolled, and 128 centrums were divided into the test group with 53 cases of PKP and the control group with 53 cases of percutaneous vertebroplasty (PVP) according to different surgical protocols. All patients underwent CT scan based on the improved V-Net, and data of centrum measurement indicators, pain score, and therapeutic evaluation results of the modified Macnab were collected. The Dice coefficient of the improved V-Net was observably higher than that of U-Net, V-Net, and CNN, while the Hausdorff distance was lower than that of U-Net, V-Net, and CNN (P < 0.05). The anterior height, central height, and posterior height of the centrum were significantly higher than those in the control group after operation (3, 5, and 7 days), while the Cobb angle of vertebral kyphosis was significantly lower than that in the control group (P < 0.05). The score of visual analog scale (VAS) and analgesic use score of patients in the test group were markedly lower than those in the control group (3, 5, and 7 days after operation), P < 0.05. Besides, the excellent and good rate of the test group was remarkably higher than that of the control group, P < 0.05. Hence, the improved V-Net had better quality of segmentation and reconstruction than the traditional deep learning network. Compared with PVP, PKP was helpful in restoring the height of the centrum in patients with osteoporotic thoracolumbar compression fractures and correct kyphosis, with better analgesic effect safety.