Factors associated with pain-related disorders and gait disturbance scores from the Japanese orthopedic association back pain evaluation questionnaire and Oswestry Disability Index in patients with osteoporosis

Development of a Dual-Plane MRI-Based Deep Learning Model to Assess the 1-Year Postoperative Outcomes in Lumbar Disc Herniation After Tubular Microdiscectomy

BACKGROUND

Tubular microdiscectomy (TMD) is a treatment for lumbar disc herniation (LDH). Although the combination of MRI and deep learning (DL) has shown promise, its application in evaluating postoperative outcomes in TMD has not been fully explored.

PURPOSE/HYPOTHESIS

To evaluate whether integrating preoperative dual-plane MRI-based DL features with clinical features can assess 1-year outcomes in TMD for LDH.

STUDY TYPE

Retrospective.

POPULATION/SUBJECTS

The study involved 548 patients who underwent TMD between January 2016 and January 2021. Training set (N = 305, mean age 51.85 ± 13.84 years, 56.4% male). Internal validation set (N = 131, mean age 51.85 ± 13.84 years, 54.2% male). External validation set (N = 112, mean age 51.54 ± 14.43 years, 50.9% male).

FIELD STRENGTH/SEQUENCE

3 T MRI with sagittal and transverse T2-weighted sequences (Fast Spin Echo).

ASSESSMENT

Ground truth labels were based on improvement rate in 1-year Japanese Orthopaedic Association (JOA) scores. Information on 42 preoperative clinical features was collected. The largest protrusions were identified from T2 MRI by three clinicians and were used to train deep learning models (ResNet50, ResNet101, and ResNet152) to extract DL features. After feature selection, three models were built, namely, clinical, DL, and combined models.

STATISTICAL TESTS

Chi-square or Fisher's exact tests was used for group comparisons. Quantitative differences were analyzed using the t-test or Mann-Whitney U test. P-values <0.05 were considered significant. Models were validated on internal and external datasets using metrics such as the area under the curve (AUC).

RESULTS

The AUCs of the clinical models achieved 0.806 (internal) and 0.779 (external). ResNet152 performed best in three DL models, with AUCs of 0.858 (internal) and 0.834 (external). The combined model achieved AUCs of 0.889 (internal) and 0.857 (external).

DATA CONCLUSION

A model combining preoperative dual-plane MRI DL features and clinical features can assess 1-year outcomes of TMD for LDH.

EVIDENCE LEVEL

4 TECHNICAL EFFICACY: Stage 2.

Assessing the Impact of Preoperative MRI-Based Vertebral Bone Quality Scores on Five-Year Prognosis in Lumbar Spine Surgery

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To assess the utility of preoperative vertebral bone quality (VBQ) scores in predicting the five-year clinical outcomes following lumbar spine surgery.

SUMMARY OF BACKGROUND DATA

Osteoporosis poses a significant concern in older adults undergoing spinal surgery. The VBQ score, assessed through preoperative magnetic resonance imaging (MRI), is associated with subsequent osteoporotic fractures and postoperative complications. However, previous report on the impact of VBQ score on mid-term clinical outcomes after lumbar spine surgery remains lacking.

MATERIALS AND METHODS

A total of 189 patients who underwent lumbar surgery (≤3 disc levels) for lumbar spinal stenosis between 2010 and 2016 were enrolled. Patients were classified into high (>3.35), middle (2.75-3.35), and low (<2.73) VBQ score groups based on tertiles. Clinical scores, including Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form-36 (SF-36), were recorded preoperatively and one, two, and five years postoperatively.

RESULTS

Comparative analysis showed significant differences among the VBQ groups throughout the study period in low back pain ( P =0.013), walking ability ( P =0.005), social life function ( P =0.010) of JOABPEQ, and physical component summary of the SF-36 ( P =0.018) following lumbar spine surgery. A higher VBQ score was significantly correlated with worse five-year postoperative outcomes for all domains except for lumbar function of the JOABPEQ using multiple linear regression analysis, adjusting for age, sex, BMI, hyperlipidemia, surgical procedures, and each preoperative score.

CONCLUSION

A high preoperative VBQ score is a risk factor for poor five-year clinical outcomes after lumbar spine surgery. Evaluation of the VBQ score through routine preoperative MRI facilitates osteoporotic screening in lumbar patients without radiation exposure and health care costs, while also demonstrating its potential as a prognostic indicator of postoperative clinical outcomes.

LEVEL OF EVIDENCE

Level III.

Migu Capsules in the Treatment of Osteoporotic Low Back Pain in Postmenopausal Women: A Single-Center Randomized Controlled Trial

Purpose

This trial aimed to investigate the efficacy of Migu capsules in treating osteoporotic low back pain.

Patients and Methods

In this single-center trial, we randomly assigned patients with osteoporotic low back pain that had lasted for 3 months in a 1:1 ratio to receive Migu capsules alongside Caltrate D in treatment group or to receive Caltrate D only in control group, both for 48 weeks. The primary outcome measure was the intensity of low back pain on a visual analog scale at 24 weeks after enrollment. Secondary outcome measures included the Roland-Morris Disability Questionnaire (RMDQ), bone turnover markers, and bone mineral density.

Results

A total of 100 patients were enrolled, with 50 in each group. At baseline, the mean score for low back pain intensity was 6.2 in the treatment group and 6.1 in the control group. The primary outcome of the low back pain intensity score at 24 weeks was 2.9 in the treatment group and 4.7 in the control group (adjusted mean difference, -1.8; 95% confidence interval, -2.3 to -1.4; P<0.001). Secondary outcomes including the score on RMDQ and pain at 48 weeks were in the same direction as the primary outcome. Compared to the control group, the treatment group only showed a difference in bone density after continuous intervention for 48 weeks (P<0.05). Three patients experienced a mild adverse event associated with the intake of Migu capsules.

Conclusion

Migu capsules can alleviate bone pain and reduce functional disabilities caused by osteoporotic lower back pain.

Efficacy and safety of minodronate in the treatment of postmenopausal osteoporosis with low back pain: a single-centre, randomized and open-label controlled trial

BACKGROUND

Low back pain is one of the most common symptoms of osteoporosis. The pain can seriously affect patients' mood and quality of life; it can also further aggravate bone loss, causing a serious social burden. Minodronate is an oral bisphosphonate that needs to be administered daily. It significantly reduces levels of bone turnover markers (BTMs) and rapidly improves symptoms of low back pain in patients with osteoporosis. Osteoporosis requires long-term treatment, and daily dosing reduces patient compliance. Minodronate has a better safety profile than other bisphosphonates. The objective of the trial is to explore the efficacy and safety of minodronate in the treatment of low back pain in postmenopausal osteoporosis patients.

METHODS

This is a single-centre, randomized, open-label controlled trial with a 24-week duration. Seventy-two eligible patients will be randomly divided into 4 groups. Subjects will be randomized at a 1:1 ratio to receive either minodronate (1 mg/day) or alendronate (10 mg/day) every day; senior women (≥ 75 years old) and older women (< 75 years old) will be at a ratio of 1:2. The primary outcome is the time required for the visual analogue scale (VAS) score to decline by ≥ 10 from baseline. The secondary outcome is the changes in VAS scores from baseline, the frequency and dosage of rescue medication, BTMs, bone mineral density (BMD), and variations in upper gastrointestinal (GI) symptom scores from baseline (including heartburn, pain, and bloating).

DISCUSSION

This study will provide objective evidence for the efficiency and safety of minodronate. Furthermore, it will be helpful to evaluate the quantitative relationship between BTMs and BMD in patients with osteoporosis under different ages.

TRIAL REGISTRATION

This study protocol has been registered with ClinicalTrials.gov ID NCT05645289 ( https://clinicaltrials.gov/search?term=NCT05645289 ) on December 8, 2022. The registry name is Peking University Third Hospital. This study protocol was reviewed and approved by the Peking University Third Hospital Medical Science Research Ethics Committee (M2022465, 2022.08.09, V2.0). The results will be published in scientific peer-reviewed journals.

TRIAL STATUS

The protocol was registered at ClinicalTrials.gov (registration number: NCT05645289). Recruitment has started in January 2023 and is still ongoing.

Iran osteoporosis registry: protocol for nationwide study

Background

Osteoporotic fractures can result in significant health complications and an increased risk of death. Registry studies could provide better treatment options and improve patient outcomes by providing useful information about the disease. The present study describes the protocol for an osteoporosis registry in Iran.

Materials and methods

This registry is a prospective multicenter cohort study recruiting patients with osteoporosis from Iran. The inclusion criteria of the study are individuals diagnosed with primary or secondary osteoporosis according to the diagnostic criteria of the study; patients will be identified and recruited from outpatient clinics in this registry. All patients diagnosed with primary or secondary osteoporosis are the target population of the study. Our expected sample size is 1000 participants and the study will continue for at least 2 years. The measurements of the Iranian Osteoporosis Registry include four parts: (i) variables measured by the specific questionnaires package, (ii) bone mineral density (BMD, (iii) clinical examination, and (iv) lab data. The final questionnaire package includes "demographics information", "socioeconomic status", "lifestyle", "reproductive health", "medical history and medication", "Osteoporosis diagnosis gap", "Osteoporosis adherence and treatment gap", "fracture history and fall risk assessment", "FRAX ® tool ", "hospitalization and death outcomes", "low back pain", "hospitalization history", "attitude toward osteoporosis", "osteoporosis awareness", "osteoporosis related-performance", "quality of life (Iranian version of SF12 questionnaire )", and "food frequency questionnaire (FFQ)". Clinical examination of this registry includes anthropometric measurements (including height, weight, body mass index (BMI), waist circumference, hip circumference, and right wrist circumference), and blood pressure. The baseline questionnaires will be filled out right after patients are diagnosed with osteoporosis and then osteoporotic patients will be followed up regularly on a yearly basis. In the follow-up visit, variables that may have changed over time are updated. The main outcomes include registration of fall, fracture, hospitalization, medication adherence, and death. An online web-based user-friendly software is also developed for data collection. Data analysis will be conducted with the collaboration of data-mining experts and epidemiologists at the end of each follow-up.

Conclusion

The Iran Osteoporosis Registry will be a valuable source of information regarding osteoporosis outcomes (i.e. fractures, hospitalizations, adherence, and death at the national level), and its results will be very beneficial and practical for policy makers in the field of musculoskeletal diseases.

Calculation of trunk muscle mass and trunk muscle quality indices for walking independence in asian patients with hip fractures

BACKGROUND & AIMS

This study aimed to investigate the association between trunk muscle mass and muscle quality, as evaluated by bioelectrical impedance analysis (BIA), and the ability to walk independently in patients with hip fractures. Cutoff values for quantitative and qualitative indicators of the trunk muscles were also calculated.

METHODS

This study included 181 patients with hip fractures who were admitted to a convalescent rehabilitation ward. Trunk muscle mass and phase angle of the participants were evaluated on admission. The phase angle in this study was defined as the trunk muscle quality index (TMQI). Patients were classified into the independent (functional independence measure [FIM]-walk score ≥6; n = 101) and non-independent (FIM-walk score ≤5; n = 80) walking groups according to the FIM mobility scores at discharge.

RESULTS

The independent group had a higher FIM gain than the non-independent group (37.0 ± 13.6 vs. 27.1 ± 13.5, p < 0.001). Logistic regression analysis showed that the trunk muscle mass index (TMI) and TMQI were associated with the ability to walk independently. Furthermore, cutoff values of TMI and TMQI for male and female to estimate the ability to walk independently were 6.5 kg/m2 and 5.7 kg/m2, and 4.5° and 3.4°, respectively.

CONCLUSION

TMI and TMQI are related to the ability to walk independently in patients with hip fractures. These results suggest the importance of improving trunk muscle mass and muscle quality during rehabilitation of patients with hip fractures.

Emphatic information on bone mineral loss using quantitative ultrasound sonometer for expeditious prediction of osteoporosis

Osteoporosis (OP) and osteoarthritis (OA) are skeletal disorders characterized by a reduction in bone density and quality, resulting in increased fragility and susceptibility to fractures. These illnesses are exhibiting a higher prevalence among both males and females. Fracture risk is determined by using the BMD score (Bone Mineral Density). Looking at the bone loss that comes with osteoarthritis (OA) and osteoporosis (OP), this study also looks at the technological methods used to test for these conditions in order to improve therapies and treatment plans for older people. As a matter of consideration, the prevalence of osteoporosis is higher among postmenopausal women (20%) compared to premenopausal women (14.28%) and males (6.77%). The utilization of a preliminary calcaneal Quantitative Ultrasound (QUS) examination is warranted in order to effectively handle the matter of osteoporosis. The prompt assessment of a patient can provide valuable insights into potential fractures and aid in the prevention of bone injury. In a nutshell, it is imperative to comprehend the impact of OA (osteoarthritis) and OP (osteoporosis) on bone health in order to effectively manage the escalating apprehensions surrounding these conditions. Sophisticated diagnostic techniques, such as the calcaneal quantitative ultrasound (QUS) test, have the potential to enhance the well-being of older individuals by enabling early detection and treatment of many ailments.

Preoperative predictors of prolonged hospitalization in patients undergoing lateral lumbar interbody fusion

PURPOSE

We aim to examine the preoperative factors associated with increased postoperative length of stay in patients undergoing LLIF in the hospital setting.

METHODS

Patient demographics, perioperative characteristics, and patient-reported outcome measures (PROMs) were collected from a single-surgeon database. Patients undergoing LLIF in the hospital setting were separated into postoperative LOS <48 h (H) and LOS ≥ 48H. Univariate analysis for preoperative characteristics was utilized to determine covariates for multivariable logistic regression. Multivariable logistic regression was then utilized to determine significant predictors of extended postoperative length of stay. Secondary univariate analysis of inpatient complications, operative, and postoperative characteristics were calculated to determine postoperative factors associated with prolonged hospitalization.

RESULTS

Two-hundred and forty patients were identified with 115 patients' LOS ≥ 48H. Univariate analysis identified age/Charlson Comorbidity Index (CCI) score/gender/insurance type/number of contiguous fused levels/preoperative PROMs of Visual Analog Scale (VAS) back/VAS leg/Patient-Reported Outcomes Measurement Information System (PROMIS-PF)/Oswestry Disability Index (ODI)/degenerative spondylolisthesis diagnoses/foraminal stenosis/central stenosis for multivariable logistic regression. Multivariable logistic regression calculated significant positive predictors of LOS ≥ 48H to be age/3-level fusion/preoperative ODI scores. Negative predictors of LOS ≥ 48H were the diagnosis of foraminal stenosis/preoperative PROMIS-PF/male gender. The secondary analysis determined that patients with longer operative time/estimated blood loss/transfusion/postoperative day 0 and 1 pain and narcotic consumption/complications of altered mental status/postoperative anemia/fever/ileus/urinary retention were associated with prolonged hospitalization.

CONCLUSION

Older patients undergoing LLIF with greater preoperative disability and 3-level fusion were more likely to require prolonged hospitalization. Male patients with higher preoperative physical function and who were diagnosed with foraminal stenosis were less likely to require prolonged hospitalization.

Muscle strength rather than appendicular skeletal muscle mass might affect spinal sagittal alignment, low back pain, and health-related quality of life

Sarcopenia is defined as decreasing in muscle strength and mass, and dynapenia is defined as decreasing in muscle strength and maintained muscle mass. This study elucidated the prevalence and characteristics of sarcopenia and dynapenia and evaluate in elderly spinal disorders patients. 1039 spinal disorders patients aged ≥ 65 years were included. We measured age, grip strength, muscle mass, spinal sagittal alignment parameters, low back pain (LBP) scores and health-related quality of life (HR-QoL) scores. Based on the previous reports, patients were categorised into normal group: NG, pre-sarcopenia group: PG, dynapenia group: DG, and sarcopenia group: SG. Pre-sarcopenia, dynapenia, and sarcopenia were found in 101 (9.7%), 249 (19.2%), and 91 (8.8%) patients, respectively. The spinal sagittal alignment parameters, trunk muscle mass, LBP, and HR-QoL scores were significantly worse in DG and SG compared with those in PG and NG. Spinal alignment, trunk muscle mass, and clinical outcomes, including LBP and HR-QoL scores, were maintained in the PG and poor in the DG and SG. Thus, intervention for muscle strength may be a treatment option for changes of spinal sagittal alignment and low back pain.

Development, validation, and visualization of a web-based nomogram to predict the effect of tubular microdiscectomy for lumbar disc herniation

Objective

The purpose of this study was to retrospectively collect the relevant clinical data of lumbar disc herniation (LDH) patients treated with the tubular microdiscectomy (TMD) technique, and to develop and validate a prediction model for predicting the treatment improvement rate of TMD in LDH patients at 1 year after surgery.

Methods

Relevant clinical data of LDH patients treated with the TMD technology were retrospectively collected. The follow-up period was 1 year after surgery. A total of 43 possible predictors were included, and the treatment improvement rate of the Japanese Orthopedic Association (JOA) score of the lumbar spine at 1 year after TMD was used as an outcome measure. The least absolute shrinkage and selection operator (LASSO) method was used to screen out the most important predictors affecting the outcome indicators. In addition, logistic regression was used to construct the model, and a nomogram of the prediction model was drawn.

Results

A total of 273 patients with LDH were included in this study. Age, occupational factors, osteoporosis, Pfirrmann classification of intervertebral disc degeneration, and preoperative Oswestry Disability Index (ODI) were screened out from the 43 possible predictors based on LASSO regression. A total of 5 predictors were included while drawing a nomogram of the model. The area under the ROC curve (AUC) value of the model was 0.795.

Conclusions

In this study, we successfully developed a good clinical prediction model that can predict the effect of TMD for LDH. A web calculator was designed on the basis of the model (https://fabinlin.shinyapps.io/DynNomapp/).

Artificial intelligence used to diagnose osteoporosis from risk factors in clinical data and proposing sports protocols

Osteoporosis (OP) is characterized by diminished bone mass and deteriorating bone structure that increases the chance of fractures in the spine, hips, and wrists. In this paper, a novel data processing method of artificial intelligence (AI) is used for evaluating, predicting, and classifying OP risk factors in clinical data of men and women separately. Additionally, artificial intelligence was used to suggest the most appropriate sports programs for treatment. Data was obtained from dual-energy x-ray absorption scanning center of Ayatollah Kashani, Milad, and Khatam al-Anbia hospitals in Tehran, Iran. The subjects included 1224 men and women. Models were developed using decision tree, random forest (RF), k-nearest neighbor, support vector machine, gradient boosting (GB), Extra trees, Ada Boost (AB), and artificial neural network multilayer perceptron analysis to predict osteoporosis and to recommend sports programs. Data was divided into training (80%) and test dataset (20%). The results were obtained on a 20% test dataset. Area under receiver operating characteristic curve (AUROC) was used to compare the performance of the models. To predict healthy individuals, osteopenia and osteoporosis, the FR algorithm with AUROC 0.91 performed best in men and the GB algorithm with AUROC 0.95 performed best in women compared to other classification algorithms. Prediction of RF algorithm in women and men with AUROC 0.96 and 0.99, respectively, showed the highest performance in diagnosing the type of exercise for healthy individuals and those with osteopenia and OP. Eight AI algorithms were developed and compared to accurately predict osteoporosis risk factors and classify individuals into three categories: healthy, osteopenia, and OP. In addition, the AI algorithms were developed to recommend the most appropriate sports programs as part of treatment. Applying the AI algorithms in a clinical setting could help primary care providers classify patients with osteoporosis and improve treatment by recommending appropriate exercise programs.

A Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Study of Jianyao Migu Granules in the Treatment of Osteopenic Low Back Pain

Purpose

This randomized controlled trial aimed to evaluate the clinical efficacy of Jianyao Migu granules (JYMGG) in the treatment of primary osteopenic low back pain (LBP).

Patients and Methods

A total of 108 patients with primary osteopenic LBP were randomly divided into the JYMGG group and placebo group. Both groups took 600 mg of oral Caltrate D daily; in addition, the JYMGG group was given oral JYMGG, while the placebo group was given placebo granules. The treatment period was 6 months for both groups. The pre- to post-treatment changes in the bone mineral density (BMD), visual analogue scale (VAS) score, Oswestry disability index (ODI), and bone turnover markers were compared between the two groups.

Results

The post-treatment VAS score and ODI were significantly lower than baseline in both groups (P<0.05). In the JYMGG group, the lumbar BMD increased from 0.88±0.07 g/cm2 to 0.90±0.13 g/cm2 and the hip BMD increased from 0.77±0.08 g/cm2 to 0.78±0.10 g/cm2, giving increases of 2.70% and 1.96% respectively, but the differences were not statistically significant. The post-treatment levels of ALP, osteocalcin, P1NP, and β-CTX were increased compared with baseline in both groups, but the differences were not statistically significant. The thyrotropin level was significantly increased after treatment in the placebo group (P<0.05). There were no abnormalities detected in routine blood and kidney function tests performed during the observation period. Some patients showed elevated liver enzymes and gastrointestinal reactions.

Conclusion

JYMGG effectively relieved the bone pain, and improved the quality of life of patients with primary osteopenic LBP.