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Lê A, Bierry G, Willaume T. The 'nutcracker' spino-laminar fracture: evaluation as a sentinel lesion of a hyperextension mechanism in cervical spine trauma. Skeletal Radiol 2024; 53:1125-1134. [PMID: 38082141 DOI: 10.1007/s00256-023-04533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 04/10/2024]
Abstract
OBJECTIVE We hypothesised that the orientation of the fracture line in the cervical vertebral arch depends on the traumatic mechanism, specifically focusing on frontal oblique spino-laminar fractures to determine if this pattern can serve as an indicator of a hyperextension mechanism of injury of the cervical spine. MATERIALS AND METHODS We reviewed the imaging records of 114 adult patients admitted to the emergency department of the Strasbourg University Hospital for severe polytrauma between January 2016 and December 2021 and who presented with a fracture of the posterior vertebral arch of the lower cervical spine on the whole-body CT scan. A radiology resident (R1) and a musculoskeletal radiologist (R2) independently read the CT scans to determine the type of vertebral arch fracture; inter- and intra-observer agreements were calculated using Cohen's Kappa test. Two musculoskeletal radiologists (R2 and R3) then reviewed the CT scans and possible MRIs to identify specific hyperextension injuries of the cervical spine. The association between frontal oblique spino-laminar fracture and hyperextension injuries was assessed using chi2 test. RESULTS Thirty-five patients had frontal oblique spino-laminar fractures of the cervical spine. These fractures were significantly associated (p = 0.001) with hyperextension injuries of the cervical spine. The inter- and intra-observer agreements for the identification of these spino-laminar fractures were very good (0.86 (0.75-0.96) and 0.90 (0.81-0.99)). CONCLUSION Frontal oblique spino-laminar fractures are easily recognisable on CT scans and significantly associated with other traumatic injuries known as resulting from hyperextension. Their identification should lead to a search for potential associated unstable vertebral disco-ligamentous injuries with MRI.
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Affiliation(s)
- Alexandre Lê
- Department of Radiology, Strasbourg University Hospital, 1 Avenue Moliere, 67098, Strasbourg, France
| | - Guillaume Bierry
- Department of Radiology, Strasbourg University Hospital, 1 Avenue Moliere, 67098, Strasbourg, France
| | - Thibault Willaume
- Department of Radiology, Strasbourg University Hospital, 1 Avenue Moliere, 67098, Strasbourg, France.
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Jeon S, Yu D, Kim S, Kim SW, Jeon I. Comparison of radiological and functional outcomes of conservative treatment with teriparatide and denosumab in thoracolumbar osteoporotic vertebral fracture. Osteoporos Int 2024; 35:795-804. [PMID: 38261013 DOI: 10.1007/s00198-024-07025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/13/2024] [Indexed: 01/24/2024]
Abstract
Teriparatide and denosumab, anti-osteoporosis medications with different mechanisms, have been widely used in the patients with osteoporotic vertebral fracture (OVF) considered as advanced osteoporosis. Teriparatide has been shown to enhance bone formation and fracture healing in OVF, but there are still no sufficient evidences discussing about the role of denosumab in newly developed OVF. In this study, we found the similar radiological deformation and functional outcomes of conservative treatment with teriparatide and denosumab in thoracolumbar (TL) OVF, and teriparatide showed a more frequent incidence of fracture union with paravertebral bone bridge formation compared to denosumab. INTRODUCTION Teriparatide and denosumab have been widely used to treat advanced osteoporosis and prevent subsequent fractures in patients with OVCF. Unlike teriparatide, which is considered to be effective in fracture healing, there is still no clear role and evidence for the effect of denosumab in acute OVCF. This study compared the radiological and functional outcomes of conservative treatment with teriparatide and denosumab in TL-OVF. METHODS This retrospective study enrolled 78 women with mean age of 74.69 ± 7.66 (60-92) years diagnosed as a TL-OVF with no neurological deficits. All patients were treated conservatively with teriparatide (34 of group T, once-daily 20 μg) or denosumab (44 of group D, once-6 months 60 mg) for 6 months. We evaluated the radiological deformation (kyphotic angle, segmental vertebral kyphotic angle, and compression ratio) and the incidence of fracture union with paravertebral bone bridge formation (FUPB) and functional outcomes using the visual analog scale (VAS) and Oswestry Disability Index (ODI) at 0, 3, and 6 months. RESULTS In the radiological deformation and functional outcomes, there were no significant differences at 0, 3, and 6 months between the two groups (P > 0.05). However, the incidence of FUPB at 6 months was higher in group T (20/34, 58.8%) compared to group D (11/44, 25.0%) (P = 0.004), and teriparatide was the most statistically significant factor for achieving FUPB (OR 4.486, P = 0.012) in multivariable logistic analysis. CONCLUSIONS Teriparatide and denosumab, despite of their different pharmacological mechanisms, showed similar radiological deformation and functional outcomes in the conservative treatment of TL-OVF. However, teriparatide showed a significantly higher incidence of fracture union with paravertebral bone bridge formation.
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Affiliation(s)
- Seongmin Jeon
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea
| | - Dongwoo Yu
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea
| | - Sungho Kim
- Department of Neurosurgery, Bogang Hospital, Daegu, South Korea
| | - Sang Woo Kim
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea
| | - Ikchan Jeon
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea.
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Kastler A, Carneiro I, Perolat R, Rudel A, Pialat JB, Lazard A, Isnard S, Krainik A, Amoretti N, Grand S, Stacoffe N. Combined vertebroplasty and pedicle screw insertion for vertebral consolidation: feasibility and technical considerations. Neuroradiology 2024; 66:855-863. [PMID: 38453715 DOI: 10.1007/s00234-024-03325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To assess the feasibility and technical accuracy of performing pedicular screw placement combined with vertebroplasty in the radiological setting. METHODS Patients who underwent combined vertebroplasty and pedicle screw insertion under combined computed tomography and fluoroscopic guidance in 4 interventional radiology centers from 2018 to 2023 were retrospectively assessed. Patient demographics, vertebral lesion type, and procedural data were analyzed. Strict intra-pedicular screw positioning was considered as technical success. Pain score was assessed according to the Visual Analogue Scale before the procedure and in the 1-month follow-up consultation. RESULTS Fifty-seven patients (38 men and 19 women) with a mean age of 72.8 (SD = 11.4) years underwent a vertebroplasty associated with pedicular screw insertion for the treatment of traumatic fractures (29 patients) and neoplastic disease (28 patients). Screw placement accuracy assessed by post-procedure CT scan was 95.7% (89/93 inserted screws). A total of 93 pedicle screw placements (36 bi-pedicular and 21 unipedicular) in 32 lumbar, 22 thoracic, and 3 cervical levels were analyzed. Mean reported procedure time was 48.8 (SD = 14.7) min and average injected cement volume was 4.4 (SD = 0.9) mL. A mean VAS score decrease of 5 points was observed at 1-month follow-up (7.7, SD = 1.3 versus 2.7, SD = 1.7), p < .001. CONCLUSION Combining a vertebroplasty and pedicle screw insertion is technically viable in the radiological setting, with a high screw positioning accuracy of 95.7%.
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Affiliation(s)
- Adrian Kastler
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France.
| | - Inês Carneiro
- Neuroradiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Romain Perolat
- Radiology Unit, Carémeau University Hospital, Nimes, France
| | - Alexandre Rudel
- Diagnostic and Interventional MSK Unit, Pasteur II Hospital, Nice, France
| | | | - Arnaud Lazard
- Neurosurgery Unit, Grenoble University Hospital, Grenoble, France
| | - Stephanie Isnard
- Neurosurgery Unit, Grenoble University Hospital, Grenoble, France
| | - Alexandre Krainik
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France
| | - Nicolas Amoretti
- Diagnostic and Interventional MSK Unit, Pasteur II Hospital, Nice, France
| | - Sylvie Grand
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France
| | - Nicolas Stacoffe
- Diagnostic and Interventional Radiology Unit, Lyon Sud Hospital, Lyon, France
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Yu W, Guan WM, Hayashi D, Lin Q, Du MM, Xia WB, Wang YXJ, Guermazi A. Vertebral fracture severity assessment on anteroposterior radiographs with a new semi-quantitative technique. Osteoporos Int 2024; 35:831-839. [PMID: 38296865 DOI: 10.1007/s00198-024-07024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024]
Abstract
We developed a new tool to assess the severity of osteoporotic vertebral fracture using radiographs of the spine. Our technique can be used in patient care by helping to stratify patients with osteoporotic vertebral fractures into appropriate treatment pathways. It can also be used for research purposes. PURPOSE The aim of our study was to propose a semi-quantitative (SQ) grading scheme for osteoporotic vertebral fracture (OVF) on anteroposterior (AP) radiographs. METHODS On AP radiographs, the vertebrae are divided into right and left halves, which are graded (A) vertical rectangle, (B) square, (C) traverse rectangle, and (D) trapezoid; whole vertebrae are graded (E) transverse band or (F) bow-tie. Type A and B were compared with normal and Genant SQ grade 1 OVF, Type C and D with grade 2 OVF, and Type E and F with grade 3 OVF. Spine AP radiographs and lateral radiographs of 50 females were assessed by AP radiographs SQ grading. After training, an experienced board-certified radiologist and a radiology trainee assessed the 50 AP radiographs. RESULTS The height-to-width ratio of the half vertebrae varied 1.32-1.48. On lateral radiographs, 84 vertebrae of the 50 patients had OVFs (38 grade 1, 24 grade 2, and 22 grade 3). On AP radiographs, the radiologist correctly assigned 84.2%, 91.7%, and 77.2% and the trainee correctly assigned 68.4%, 79.2%, and 81.8% of grade 1, 2, and 3 OVFs, respectively. Compared with lateral radiographs, the radiologist had a weighted Kappa of 0.944 including normal vertebrae and 0.883 not including normal vertebrae, while the corresponding Kappa values for the trainee were 0.891 and 0.830, respectively. CONCLUSION We propose a new semi-quantitative grading system for vertebral fracture severity assessment on AP spine radiographs.
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Affiliation(s)
- W Yu
- Department of Radiology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.
| | - W-M Guan
- Department of Radiology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - D Hayashi
- Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Q Lin
- Department of Radiology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
- Department of Radiology, Beijing Arion Cancer Center, Beijing, China
| | - M-M Du
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Zhejiang Province, Wenzhou, China
| | - W-B Xia
- Department of Endocrinology, Chinese Academy Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Y-X J Wang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - A Guermazi
- Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA
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Bertulli L, Pileggi M, Marchi F, Scarone P, Cianfoni A. 'Armed kyphoplasty' with posterior stabilization avoids corpectomy in complex thoracolumbar spine fractures: a case series. J Neurointerv Surg 2024; 16:436-442. [PMID: 38262730 DOI: 10.1136/jnis-2023-021114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Complex thoracolumbar fractures require reduction and stabilization. Posterior instrumentation alone and standard cement augmentation may represent undertreatment, while corpectomy has significant morbidity. In a series of unstable thoracolumbar fractures, we assessed the feasibility, safety, and results of 'armed kyphoplasty' (AKP) and surgical posterior stabilization (PS). METHODS A total of 24 consecutive patients were treated with combined AKP and PS. Minimally invasive and open surgery techniques were used for PS. AKP was performed with C-arm or biplane fluoroscopic guidance, and screws were placed under navigation or fluoroscopic guidance. A postoperative CT scan and standing plain films were obtained. Patients were followed up according to clinical standards. Kyphosis correction (measured with regional Cobb angle), pain (measured with the Numeric Rating Scale), neurological status (measured with Frankel grade) were assessed. RESULTS A total of 25 fractures of neoplastic (40%), traumatic (32%), and osteoporotic (28%) nature were treated. Open surgery and minimally invasive techniques were applied in 16/24 and 8/24 patients, respectively. Decompressive laminectomy was performed in 13 cases. No intraprocedural complications occurred. Two patients (8%) died due to underlying disease complications and three complications (12%) required re-intervention (one surgical site infection, one adjacent fracture, and one screw pull-out) in the first month. The mean Cobb angle was 20.14±6.19° before treatment and 11.66±5.24° after treatment (P<0.0001). No re-fractures occurred at the treated levels. CONCLUSIONS Combined AKP and PS is feasible and effective in the treatment of complex thoracolumbar fractures of all etiologies. AKP avoided highly invasive corpectomy. Anterior and posterior support ensured stability, preventing implant failure and re-fracture. The complication rate was low compared with more invasive traditional 360° open surgical approaches.
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Affiliation(s)
- Lorenzo Bertulli
- Department of Neurosurgery, KSW Kantonsspital Winterthur, Winterthur, Zurich, Switzerland
| | - Marco Pileggi
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Ticino, Switzerland
| | - Francesco Marchi
- Department of Neurosurgery, Neurocenter of Southern Switzerland EOC, Lugano, Ticino, Switzerland
| | - Pietro Scarone
- Centre of Spine Surgery, Clinica Santa Chiara, Locarno, Switzerland
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Ticino, Switzerland
- Department of Neuroradiology, Inselspital Bern, University of Bern, Bern, Switzerland
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Liao S, Xu Y, Liu J, Jiang L, Dai G, Wang Y. Risk factors for nonunion of osteoporotic vertebral compression fracture: a case‒control study. BMC Musculoskelet Disord 2024; 25:295. [PMID: 38627756 PMCID: PMC11020417 DOI: 10.1186/s12891-024-07386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Early assessment of the risk of nonunion in osteoporotic vertebral compression fracture (OVCF) is beneficial to early clinical decision making. However, a comprehensive understanding of the risk factors for OVCF nonunion is lacking. METHODS We conducted a case-control study to investigate risk factors for OVCF nonunion. Patients who underwent surgery for nonunited OVCFs between January 2011 and December 2021 were eligible for inclusion as cases. Patients with successful OVCF healing confirmed by MRI over the same period were identified as controls. Patient demographics, comorbidities, and fasting blood test data were extracted for analysis. RESULTS A total of 201 patients with nonunited OVCFs and 1044 controls were included to evaluate the risk factors for nonunited OVCFs. There were statistically significant differences in sex, age, number of patients with hypertension, number of patients on bed rest after OVCF and T-score of BMD between the two groups. Logistic regression showed that female patients had a higher risk of OVCF nonunion than male patients and that smoking, drinking, diabetes, and hypertension were risk factors for nonunion of OVCFs, while bed rest and spinal support were protective factors against nonunion of OVCFs. We also found that age, BMD, FBG, and β-CTX were positively correlated with nonunited OVCFs, and that HGB and 1,25-(OH)2VitD3 level were negatively correlated with nonunited OVCFs. CONCLUSION Smoking, drinking, diabetes and hypertension were risk factors for nonunion of OVCFs, while bed rest and spinal support were protective factors against nonunion of OVCFs. Age, BMD, FBG and β-CTX were positively correlated with nonunited OVCFs, while HGB and 1,25-(OH)2VitD3 level were negatively correlated with nonunited OVCFs. Based on the results of our study, we suggest that bed rest or spinal support for at least 3 consecutive weeks is necessary to reduce the risk of OVCFs nonunion.
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Affiliation(s)
- Shichuan Liao
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, No. 132 West First Section First Ring Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Yan Xu
- Experiment Teaching Center for Preclinical Medicine, Chengdu Medical College, No. 783, Xindu Avenue, Xindu District, Chengdu, Sichuan Province, China
| | - Jing Liu
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, No. 132 West First Section First Ring Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Ling Jiang
- College Hospital, Sichuan Agricultural University-Chengdu Campus, No. 211 Huiming Road, Wenjiang district, Chengdu, Sichuan Province, China
| | - Guogang Dai
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, No. 132 West First Section First Ring Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Yi Wang
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, No. 132 West First Section First Ring Road, Wuhou District, Chengdu, 610041, Sichuan Province, China.
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Li Q, Wang S, Wang Q, Yan P, Yang J. Percutaneous kyphoplasty through unilateral puncture on the convex side for the treatment of painful osteoporotic vertebral compression fracture with scoliosis. BMC Musculoskelet Disord 2024; 25:294. [PMID: 38627655 PMCID: PMC11020640 DOI: 10.1186/s12891-024-07399-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/30/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE To assess the clinical safety, accuracy, and efficacy of percutaneous kyphoplasty (PKP) surgery using an enhanced method of unilateral puncture on the convex side for the treatment of painful osteoporotic vertebral compression fractures (P-OVCF) with scoliosis. METHODS Clinical and radiographic data of P-OVCF patients with scoliosis who underwent PKP via unilateral puncture on the convex side from January 2018 to December 2021 were retrospectively analyzed. This technique's detailed surgical steps and tips were described. The local kyphosis angle (LKA), scoliosis Cobb angle (SCA), and local scoliosis Cobb angle (LSCA) were measured using X-ray and compared at pre-operation, post-operation, and the last follow-up. The width of pedicle (POW), inner inclination angle (IIA), lateral distance (LD), and puncture course length (PCL) were measured on the axial computed tomography image and compared between two sides. Postoperative computed tomography was employed to evaluate the condition of cement distribution and puncture. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back pain (BP). RESULTS Thirty-six patients, 23 women and 13 men, with an average age of 76.31 ± 6.28 years were monitored for 17.69 ± 4.70 months. The median surgical duration of single vertebrae was 35 min. The volume of bone cement for single vertebrae was 3.81 ± 0.87 ml and the proportion of sufficient cement distribution of the patients was 97.22. LKA was considerably improved from pre-operation to post-operation and sustained at the last follow-up. SCA and LSCA were not significantly modified between these three-time points. IIA, PCL, and LD were lower on the convex side than on the concave side. POW was considerably wider on the convex side. The ODI and VAS-BP scores were significantly improved after surgery and sustained during the follow-up. CONCLUSIONS Combining with the proper assessment of the pre-injured life status of patients, PKP surgery using unilateral puncture on the convex side for the treatment of P-OVCF with scoliosis can achieve safe, excellent clinical, and radiographic outcomes.
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Affiliation(s)
- Qiuhan Li
- Department of Clinical skills center, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China
| | - Song Wang
- Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China.
| | - Qing Wang
- Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China.
| | - Pijun Yan
- Department of endocrinology, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China
| | - Jin Yang
- Department of Orthopedics Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Road, Luzhou, 646000, Sichuan, China.
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Tang Y, Li H, Ruan X, Yang H, Sun J, Chen K. Percutaneous kyphoplasty with or without posterior pedicle screw fixation for the management of severe osteoporotic vertebral compression fractures with nonunion. J Orthop Surg Res 2024; 19:240. [PMID: 38622736 PMCID: PMC11017672 DOI: 10.1186/s13018-024-04714-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE To assess the radiographic outcomes, clinical outcomes and complications of percutaneous kyphoplasty (PKP) with and without posterior pedicle screw fixation (PPSF) in the treatment of severe osteoporotic vertebral compression fractures (sOVCF) with nonunion. METHODS This study involved 51 patients with sOVCF with nonunion who underwent PKP or PPSF + KP. The operation time, intraoperative blood loss, volume of injected bone cement, operation costs and hospital stays were all recorded. In addition, the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were assessed separately for each patient before and after surgery. RESULTS Compared with the PPSF + KP group, the PKP group had shorter operation time, less intraoperative blood loss, shorter hospital stays and fewer operation costs. However, cobb's angle improvement (13.4 ± 4.3° vs. 21.4 ± 5.3°), VWR improvement ratio (30.4 ± 11.5% vs. 52.8 ± 12.7%), HA (34.9 ± 9.0% vs. 63.7 ± 7.6%) and HM (28.4 ± 11.2% vs. 49.6 ± 7.7%) improvement ratio were all higher in PPSF + KP group than that in PKP group. In addition, the ODI index and VAS score in both groups were significantly decreased at the postoperative and final follow-up. PKP group's postoperative VAS score was significantly lower than that in PPSF + KP group, but there was no statistically significant difference in VAS score at the last follow-up. CONCLUSION PKP and PPSF + KP can both effectively relieve the pain associated with sOVCF with nonunion. PPSF + KP can achieve more satisfactory vertebral reduction effects compared to PKP. However, PKP was less invasive and it has more advantages in shortening operation time and hospital stay, as well as decreasing intraoperative blood loss and operation costs.
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Affiliation(s)
- Yingchuang Tang
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hanwen Li
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xingbang Ruan
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Jiajia Sun
- First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Kangwu Chen
- First Affiliated Hospital of Soochow University, Suzhou, China.
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Piazzolla A, Bizzoca D, Barbanti-Brodano G, Formica M, Pietrogrande L, Tarantino U, Setti S, Moretti B, Solarino G. Capacitive biophysical stimulation improves the healing of vertebral fragility fractures: a prospective multicentre randomized controlled trial. J Orthop Traumatol 2024; 25:17. [PMID: 38622334 PMCID: PMC11018575 DOI: 10.1186/s10195-024-00758-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/03/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Capacitively coupling electric fields (CCEF) is a method of non-invasive biophysical stimulation that enhances fracture repair and spinal fusion. This multicentre randomized controlled trial aimed to further examine the roles of CCEF in (1) the resolution of vertebral bone marrow oedema (VBME) using a follow-up MRI study and (2) pain relief, analgesic drug consumption and quality of life improvement in stimulated patients who were referred with acute vertebral fragility fractures (VFFs) compared to non-stimulated patients. METHODS Between September 2016 and December 2019, patients who were referred to the spine centres that participated in this multicentre randomized clinical study with acute VFFs of type OF1 or OF2 were included in the present study. All the VFFs were conservatively managed according to Good Clinical Practice. Moreover, the patients were randomized into two groups: the CCEF group received, as an adjunct to the clinical study protocol, biophysical stimulation with a CCEF device (Osteospine, IGEA) for 8 h per day for 60 days, whereas the control group was treated according to the clinical study protocol. At baseline (T0), the 30-day follow-up (T1), the 60-day follow-up (T2), and the 6-month follow-up (T3), each patient underwent clinical evaluation using the Visual Analogue Scale (VAS) for Pain and the Oswestry Disability Index (ODI). Analgesic therapy with paracetamol 1000 mg tablets for 7 days-or longer, depending on the pain intensity-was performed; patients were required to report their paracetamol consumption on a specific sheet between study day 8 to 180 days of follow-up. MRI studies of the thoracolumbar spine were performed at 0 (T0), 30 (T1) and 60 days of follow-up (T2) using a 1.5-T MRI system in all of the centres that took part in the study. For each VBME area examined via MRI, the vertebral body geometry (i.e. anterior wall height/posterior wall height and vertebral kyphosis) were assessed. RESULTS A total of 66 patients (male: 9, 13.63%; mean age: 73.15 years old) with 69 VFFs were included in the present study and randomized as follows: 33 patients were included in the control group and the remaining 33 patients were randomized into the CCEF group. In the CCEF group, good compliance with CCEF therapy was observed (adherence = 94%), and no adverse effects were recorded. In the stimulated patients, faster VBME resolution and significantly less vertebral body collapse during follow-up were observed compared to the control patients. Moreover, in the active group, faster pain reduction and improvement in the ODI mean score were observed. Stimulated patients also reported a significantly lower paracetamol consumption rate from the third follow-up after treatment until the 6-month follow-up. In terms of sex-related differences, in the CCEF group, VBME showed a faster resolution in male patients compared with females. CONCLUSION Biophysical stimulation with CCEF, as an adjunct to traditional conservative treatment, is a useful tool to hasten the VBME resolution process and prevent vertebral body deformation. These MRI findings also correlate with faster back pain resolution and quality of life improvement. From the third follow-up after treatment until the 6-month follow-up, stimulated patients reported a significantly lower paracetamol consumption than control patients, even though back pain and quality of life showed no significant differences between the two groups. LEVEL OF EVIDENCE II. Trial Registration Register: ClinicalTrials.gov, number: NCT05803681.
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Affiliation(s)
- Andrea Piazzolla
- UOSD Spine Surgery, AOU Consorziale Policlinico di Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Davide Bizzoca
- UOSD Spine Surgery, AOU Consorziale Policlinico di Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | | | - Matteo Formica
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genova, Genoa, Italy
- Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Pietrogrande
- Orthopedics and Traumatology Unit, Department of Health Sciences, San Paolo University Hospital, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, University of Milan Medical School, Milan, Italy
| | - Umberto Tarantino
- Department of Orthopedics and Traumatology, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy
| | - Stefania Setti
- Clinical Biophysics, IGEA SpA, Via Parmenide, 10/A, 41012, Carpi, Italy
| | - Biagio Moretti
- Orthopaedic and Trauma Unit, Department DiBraiN, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Giuseppe Solarino
- Orthopaedic and Trauma Unit, Department DiBraiN, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
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Blixt S, Burmeister F, Mukka S, Bobinski L, Försth P, Westin O, Gerdhem P. Reliability of thoracolumbar burst fracture classification in the Swedish Fracture Register. BMC Musculoskelet Disord 2024; 25:281. [PMID: 38609938 PMCID: PMC11010401 DOI: 10.1186/s12891-024-07395-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The Swedish Fracture Register (SFR) is a national quality register for all types of fractures in Sweden. Spine fractures have been included since 2015 and are classified using a modified AOSpine classification. The aim of this study was to determine the accuracy of the classification of thoracolumbar burst fractures in the SFR. METHODS Assessments of medical images were conducted in 277 consecutive patients with a thoracolumbar burst fracture (T10-L3) identified in the SFR. Two independent reviewers classified the fractures according to the AOSpine classification, with a third reviewer resolving disagreement. The combined results of the reviewers were considered the gold standard. The intra- and inter-rater reliability of the reviewers was determined with Cohen's kappa and percent agreement. The SFR classification was compared with the gold standard using positive predictive values (PPV), Cohen's kappa and percent agreement. RESULTS The reliability between reviewers was high (Cohen's kappa 0.70-0.97). The PPV for correctly classifying burst fractures in the SFR was high irrespective of physician experience (76-89%), treatment (82% non-operative, 95% operative) and hospital type (83% county, 95% university). The inter-rater reliability of B-type injuries and the overall SFR classification compared with the gold standard was low (Cohen's kappa 0.16 and 0.17 respectively). CONCLUSIONS The SFR demonstrates a high PPV for accurately classifying burst fractures, regardless of physician experience, treatment and hospital type. However, the reliability of B-type injuries and overall classification in the SFR was found to be low. Future studies on burst fractures using SFR data where classification is important should include a review of medical images to verify the diagnosis.
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Affiliation(s)
- Simon Blixt
- Department of Orthopaedics and Hand surgery, Uppsala University Hospital, Uppsala, Sweden.
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
- Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Fabian Burmeister
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden
| | - Lukas Bobinski
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden
| | - Peter Försth
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Olof Westin
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Spine Surgery Unit, Orthopedic Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paul Gerdhem
- Department of Orthopaedics and Hand surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Zhang Y, Lu Y, Lin W, Yao M, Song J, Ding L. Surgical management of lower limb radiculopathy following acute singe-level osteoporotic vertebral fracture of lower lumbar spine in geriatric patient: a retrospective study. BMC Musculoskelet Disord 2024; 25:262. [PMID: 38570760 PMCID: PMC10988790 DOI: 10.1186/s12891-024-07314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Radiculopathy of the lower limb after acute osteoporotic vertebral fractures (OVFs) in the lower lumbar spine is uncommon in geriatric patients. Moreover, surgical intervention is generally recommended in patients who are irresponsive to conservative treatment. Determining an optimum surgical strategy is challenging considering the poor general condition of this population. Thus, herein, we established an algorithm for surgically managing this clinical scenario, hoping to provide a reference for making a surgical decision. METHODS We retrospectively studied patients who suffered from new-onset radiculopathy of the lower limb after acute single-level OVFs in the lower lumbar spine and eventually underwent surgical intervention at our department. Information on the demographics, bone quality, AO spine classification of the vertebral fracture, pre-existing degenerative changes, including foraminal stenosis and lumbar disc herniation, and surgical intervention type was collected. Additionally, clinical outcomes, including preoperative and postoperative visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI), and MacNab criterion for response to surgery, were evaluated. RESULTS From September 2019 to December 2021, a total of 22 patients with a mean age of 68.59 ± 9.74 years were analyzed. The most involved vertebra was L5 (54.5%), followed by L4 (27.3%) and L3 (18.2%). Among the 22 patients, 15 (68.2%) were diagnosed with the A1 type fracture of AO classification, and among them, 11 (73.3%) were characterized by the collapse of the inferior end plate (IEP). Three patients (13.6%) suffered from A2-type fractures, whereas four patients (18.2%) suffered from A3-type fractures. Pre-existing degenerative changes were observed in 12 patients (54.5%) of the patients. A total of 16 patients (72.7%) were treated by percutaneous kyphoplasty (PKP). Additionally, three patients underwent posterior instrumentation and fusion, two patients underwent a secondary endoscopic foraminoplasty, and one patient underwent a secondary radiofrequency ablation. The mean follow-up period was 17.42 ± 9.62 months. The mean VAS scores for leg and back pain and ODI decreased significantly after the surgery (P < 0.05). The total satisfaction rate at the last follow-up was 90.9% per the Macnab criterion. CONCLUSION Patients with OVFs in the IEP are predisposed to suffer from radiculopathy of the lower limb. PKP alone or in combination with other minimally invasive surgical strategies is safe and effective in treating stable fractures. Additionally, aggressive surgical intervention should be considered in patients with unstable fractures or severe foraminal encroachment.
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Affiliation(s)
- Yao Zhang
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China
| | - Yuzheng Lu
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China
| | - Wancheng Lin
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China
| | - Mingtao Yao
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China
| | - Jipeng Song
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China.
| | - Lixiang Ding
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China.
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Tokashiki T, Igarashi T, Shiraishi M, Kano R, Ojiri H. Evaluation of the association between osteoporotic vertebral compression fractures and psoas major/paraspinal muscle mass and ADC measured on MRI. Skeletal Radiol 2024; 53:675-682. [PMID: 37831148 DOI: 10.1007/s00256-023-04461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Evaluate magnetic resonance imaging factors associated with osteoporotic vertebral compression fractures. MATERIALS AND METHODS We retrospectively reviewed 457 patients' records. Age, sex, and body mass index were recorded. Two blinded readers measured psoas major and paraspinal muscle areas at the L3 vertebral body level on transverse T2-weighted magnetic resonance images and the mean apparent diffusion coefficient values of the non-fractured vertebrae from Th12 to L5. Inter-reader reliability for continuous variables was assessed by intraclass correlation coefficients. RESULTS We evaluated 210 patients (103 [49.0%] men). The osteoporotic vertebral compression fractures group was older and had lower BMI and smaller psoas major and paraspinal muscle areas than the group without vertebral compression fractures (p < 0.001). The mean apparent diffusion coefficient was weakly correlated with paraspinal muscle area in the osteoporotic vertebral compression fractures group. The intraclass correlation coefficient value was 0.83, and the intraclass correlation coefficients of the psoas major and paraspinal muscles were 0.94 and 0.97, respectively. Multivariate analysis revealed that decreased psoas major and paraspinal muscle areas and increased mean apparent diffusion coefficient values were significantly associated with the presence of osteoporotic vertebral compression fractures (all p < 0.05). Psoas major and paraspinal muscle areas showed relatively high predictive accuracy (57%, 61%). CONCLUSION Psoas major and paraspinal muscle areas at the L3 level and the mean apparent diffusion coefficient value of non-fractured vertebrae from the Th12 to L5 level were associated with osteoporotic vertebral compression fractures. This may contribute to detecting the potential risk of healthy individuals developing osteoporotic vertebral compression fractures.
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Affiliation(s)
- Tadashi Tokashiki
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan.
| | - Takao Igarashi
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Megumi Shiraishi
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Rui Kano
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
| | - Hiroya Ojiri
- Department of Radiology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-Ku, Tokyo, Japan
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Aly MM, Soliman Y, Elemam RA, Pizones J, Alzahrani A, Elwatidy S. How frequently MRI modifies thoracolumbar fractures' classification or decision-making? A systematic review and meta-analysis. Eur Spine J 2024; 33:1540-1549. [PMID: 38342842 DOI: 10.1007/s00586-023-08087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 07/31/2023] [Accepted: 12/05/2023] [Indexed: 02/13/2024]
Abstract
PURPOSE To provide the first meta-analysis of the impact of magnetic resonance imaging (MRI) on thoracolumbar fractures (TLFs) classification and decision-making. METHODS A systematic review was conducted following PRISMA guidelines. We searched PubMed, Scopus, Cochrane, and Web of Science from inception to June 30, 2023 for studies evaluating the change in TLFs classification and treatment decisions after MRI. The studies extracted key findings, objectives, and patient population. A meta-analysis was performed for the pooled frequency of change in AO fracture classification or treatment decisions from surgical to conservative or vice versa after MRI. RESULTS This meta-analysis included four studies comprising 554 patients. The pooled frequency of change in TLFs classification was 17% (95% CI 9-31%), and treatment decision was 22% (95% CI 11-40%). An upgrade from type A to type B was reported in 15.7% (95% CI 7.2-30.6%), and downgrading type B to type A in 1.2% (95% CI 0.17-8.3%). A change from conservative to surgery recommendation of 17% (95% CI 5.0-43%) was higher than a change from surgery to conservative 2% (95% CI 1-34%). CONCLUSIONS MRI can significantly change the thoracolumbar classification and decision-making, primarily due to upgrading type A to type B fractures and changing from conservative to surgery, respectively. These findings suggest that MRI could change decision-making sufficiently to justify its use for TLFs. Type A subtypes, indeterminate PLC status, and spine regions might help to predict a change in TLFs' classification. However, more studies are needed to confirm the association of these variables with changes in treatment decisions to set the indications of MRI in neurologically intact patients with TLFs. An interactive version of our analysis can be accessed from here: https://databoard.shinyapps.io/mri_spine/ .
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Affiliation(s)
- Mohamed M Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, P.O Box 54146, 11514, Riyadh, Saudi Arabia.
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt.
| | | | | | - Javier Pizones
- Unidad de Columna, Hospital Universitario La Paz, Madrid, Spain
| | - Ahmed Alzahrani
- Department of Neurosurgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Sherif Elwatidy
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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14
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Rieger LK, Shah A, Schick S, Draper DB, Cutlan R, Peldschus S, Stemper BD. Subject-Specific Geometry of FE Lumbar Spine Models for the Replication of Fracture Locations Using Dynamic Drop Tests. Ann Biomed Eng 2024; 52:816-831. [PMID: 38374520 DOI: 10.1007/s10439-023-03402-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/28/2023] [Indexed: 02/21/2024]
Abstract
For traumatic lumbar spine injuries, the mechanisms and influence of anthropometrical variation are not yet fully understood under dynamic loading. Our objective was to evaluate whether geometrically subject-specific explicit finite element (FE) lumbar spine models based on state-of-the-art clinical CT data combined with general material properties from the literature could replicate the experimental responses and the fracture locations via a dynamic drop tower-test setup. The experimental CT datasets from a dynamic drop tower-test setup were used to create anatomical details of four lumbar spine models (T12 to L5). The soft tissues from THUMS v4.1 were integrated by morphing. Each model was simulated with the corresponding loading and boundary conditions from the dynamic lumbar spine tests that produced differing injuries and injury locations. The simulations resulted in force, moment, and kinematic responses that effectively matched the experimental data. The pressure distribution within the models was used to compare the fracture occurrence and location. The spinal levels that sustained vertebral body fracture in the experiment showed higher simulation pressure values in the anterior elements than those in the levels that did not fracture in the reference experiments. Similarly, the spinal levels that sustained posterior element fracture in the experiments showed higher simulation pressure values in the vertebral posterior structures compared to those in the levels that did not sustain fracture. Our study showed that the incorporation of the spinal geometry and orientation could be used to replicate the fracture type and location under dynamic loading. Our results provided an understanding of the lumbar injury mechanisms and knowledge on the load thresholds that could be used for injury prediction with explicit FE lumbar spine models.
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Affiliation(s)
- Laura K Rieger
- Biomechanics and Accident Analysis, Ludwig-Maximilians-Universität (LMU), Munich, Germany.
- Occupant Protection System & Virtual Function Development, Volkswagen AG, Letter Box 011/1606, 38436, Wolfsburg, Germany.
| | - Alok Shah
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
- Neuroscience Research, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Sylvia Schick
- Biomechanics and Accident Analysis, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Dustin B Draper
- Biomechanics and Accident Analysis, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Rachel Cutlan
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steffen Peldschus
- Biomechanics and Accident Analysis, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Brian D Stemper
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
- Neuroscience Research, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
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Brakopp FH, Mendel T, Klauke F, Hofmann GO, Schenk P, Bäumlein M, Ullrich B. The Halofixator for the Treatment of Unstable Fractures of the Upper Cervical Spine - Our Own Experience and Narrative Review. Z Orthop Unfall 2024; 162:199-210. [PMID: 36657453 DOI: 10.1055/a-1957-6053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION In the treatment of upper cervical spine injuries, the semiconservative procedure of the halofixator is now of only secondary importance. Older studies from the 2000 s showed unsatisfactory rates of consolidation as well as high rates of complications. However, due to current data on therapy effectiveness, the literature is inconsistent. The aim of this work is to compare our own experiences and results of treatment with the current literature and to help to clarify the role of the halofixator. MATERIAL AND METHODS In a monocentric retrospective cohort study, patients with unstable injuries of the axial cervical spine who were to be treated in the halofixator were investigated. Individual variables (sex, age, concomitant diseases, Charlson Comorbidity Index) and treatment characteristics (duration of treatment, consolidation status, complications) were recorded using the electronic medical record. Injuries were classified based on CT data at the time of the accident and at the end of treatment, using common classification systems, and assessed with respect to the rate of consolidation. Possible factors influencing bony consolidation as well as complications were statistically analysed. RESULTS A total of 54 patients met the inclusion criteria. The median duration of treatment was 83 days. The most common injuries were isolated atlas fracture type III (7; 13%) and isolated dens fracture type III (24; 44%). Bony consolidation was demonstrated in 34 cases (63%) and tight pseudarthrosis in 13 cases (24%). Secondary surgical stabilisation was performed in 6 cases (11%). Isolated type III atlas fractures and type III dens fractures had very high consolidation rates of 86% and 92%, respectively. In the subgroups of patients older than 65 years or with a CCI ≥ 4, unstable pseudarthroses were found more frequently. Complications included pin infection (6%), pin dislocation (9%), and pressure ulceration from the halo vest (6%). Cardiopulmonary complications did not occur. No patient died. DISCUSSION Good rates of bony consolidation were seen for atlas fractures type III as well as dens fractures type III, which correlate with data in the literature. Dens fractures type II (isolated and combined) and atlas fractures type III in combination with dens fractures showed a worse radiological outcome, which is also unsatisfactory compared to the literature. The rates for procedure-specific complications were relatively low. In particular, work from recent years has demonstrated very good rates for bony consolidation and low complication rates for the treatment of atlas and/or dens fractures with the halofixator, which are confirmed by our results. In contrast, however, a significantly higher cardiac/respiratory complication rate has been reported than occurred in our own patient population.
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Affiliation(s)
- Florian Hans Brakopp
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Halle, Deutschland
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Thomas Mendel
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Halle, Deutschland
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Friederike Klauke
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Halle, Deutschland
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Gunter O Hofmann
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Halle, Deutschland
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Philipp Schenk
- Koordinationsabteilung Wissenschaft, Forschung und Lehre, BG Klinikum Bergmannstrost Halle, Halle, Deutschland
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Martin Bäumlein
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH Standort Gießen, Marburg, Deutschland
| | - Bernhard Ullrich
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Halle, Deutschland
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Jena, Deutschland
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Frati A, Cimatti M, Ileyassoff H, Capobianco M, Santoro A, Armocida D. Combined Anterior Odontoid Screw Fixation and C1-C2 Jefferson Fracture Anterior Fixation: A Step-by-Step Technical Note. World Neurosurg 2024; 184:112-118. [PMID: 38266989 DOI: 10.1016/j.wneu.2024.01.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Combined triple atlas (C1)-axis (C2) fixation has been described in previous literature as a safe, effective, and minimally invasive procedure for complex atlas and odontoid fractures that allows for a greater range of motion compared with posterior approaches and atlanto-occipital fusion. However, it is rarely performed due to the occipital-cervical diastasis resulting from often-fractured C1 joint masses. No evidence-based consensus has been reached regarding the treatment of complex atlantoaxial fractures, and the choice of surgical strategy is based only on clinical experience. METHODS We report the combined triple C1-C2 fixation technique with manual reduction of the joint masses during patient positioning on the operating table, which allowed for effective stabilization during a single surgical session. We describe our experience in the management of a 75-year-old patient presenting with an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis. RESULTS We provide a step-by-step guide for combined triple C1-C2 anterior fixation with manual fracture reduction and describe the clinical case of an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis. CONCLUSIONS Combined triple C1-C2 fixation represents a safe and efficient minimally invasive anterior approach for complex type II fractures of C1 with type II odontoid fractures. Manual reduction of the joint masses during patient positioning allows for effective stabilization in a single surgical session.
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Affiliation(s)
- Alessandro Frati
- Experimental Neurosurgery Unit, IRCCS Ist Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Marco Cimatti
- Neurosurgery Service, Azienda Ospedaliera-Universitaria Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Hernán Ileyassoff
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Mattia Capobianco
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Daniele Armocida
- Experimental Neurosurgery Unit, IRCCS Ist Neurologico Mediterraneo Neuromed, Pozzilli, Italy; Department of Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
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17
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Lainé G, Mezjan I, Masson D, Civit T, Mansouri N. Risk factors for kyphosis recurrence after implant removal in percutaneous osteosynthesis for post-traumatic thoracolumbar fracture. Eur Spine J 2024; 33:1597-1606. [PMID: 37606724 DOI: 10.1007/s00586-023-07895-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Short-segment minimally invasive percutaneous spinal osteosynthesis has now become one of the treatments of choice to treat thoracolumbar fractures. The question of implant removal once the fracture has healed is still a matter of debate since this procedure can be associated with loss of sagittal correction. Therefore, we analyzed risk factors for kyphosis recurrence after spinal implants removal in patients treated with short-segment minimally invasive percutaneous spinal instrumentation for a thoracolumbar fracture. METHODS A total of 32 patients who underwent implant removal in percutaneous osteosynthesis for post-traumatic thoracolumbar fracture were enrolled in our study. Patient's medical record, operative report and imaging examinations carried out at the trauma and during the follow-up were analyzed. RESULTS Every patient experienced fracture union. Vertebral kyphotic angle (VKA) and Cobb angle (CA) improved significantly after stabilization surgery. VKA, CA, upper disk kyphotic angle (UDKA) and lower disk kyphotic angle (LDKA) significantly gradually decreased during follow-up. Traumatic disk injury (p: 0.001), younger age (p: 0.01), canal compromise (p: 0.04) and importance of surgical correction (p < 0.001) were significantly associated with kyphosis recurrence after implant removal. Anterior body augmentation did not affect loss of correction (CA and VKA) during the follow-up period (p: 0.57). CONCLUSION Despite correction of the fracture after stabilization, we observed a progressive loss of correction over time appearing even before implant removal. Particular attention should be paid to post-traumatic disk damage or canal invasion, to young patients and to surgical overcorrection of the traumatic kyphosis.
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Affiliation(s)
- G Lainé
- Department of Neurosurgery, Polyclinique Pau Pyrénées, 8 Boulevard Hauterive, 64000, Pau, France.
| | - I Mezjan
- Department of Neurosurgery, Hopital Central, Centre Hospitalier Région Universitaire de Nancy, 29 Avenue Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - D Masson
- Department of Neurosurgery, Hopital Central, Centre Hospitalier Région Universitaire de Nancy, 29 Avenue Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - T Civit
- Department of Neurosurgery, Hopital Central, Centre Hospitalier Région Universitaire de Nancy, 29 Avenue Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - N Mansouri
- Department of Neurosurgery, Hopital Central, Centre Hospitalier Région Universitaire de Nancy, 29 Avenue Maréchal de Lattre de Tassigny, 54000, Nancy, France
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18
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Zhang J, Xu Y, Lu W, Sun F, Li H. Changes of inflammatory cytokines in vertebral compression fractures patients with percutaneous balloon kyphoplasty. Br J Neurosurg 2024; 38:231-235. [PMID: 33136440 DOI: 10.1080/02688697.2020.1823941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
Objective: To explore the changes of a series of cytokines before and after percutaneous balloon kyphoplasty (PKP) and prognostic markers for response to PKP.Methods: From 1 January 2019 to 31 May 2019, all single-level lumbar osteoporotic vertebral compression fracture (OVCF) patients diagnosed by MRI who matched the inclusion and exclusion criteria were enrolled in this study. They were classified into the effective group and the ineffective group based on the outcome after PKP. The levels of a series of inflammatory factors and indices of spinal functions were obtained before and after PKP.Results: A total of 72 patients were included in this study, 59 in the effective group and 13 in the ineffective group. The anterior height (AH) and posterior height (PH) were 77.3 ± 11.2% and 91.2 ± 9.3%, respectively, in the effective group after PKP, which were higher than that in the ineffective group (p<.001). While, the Kyphotic angle, visual analog scale (VAS), and Oswestry Disability Index (ODI) score were 9.1 ± 4.3°, 3.1 ± 1.9, and 19.2 ± 4.1 in the effective group, which was lower than that in ineffective group (p<.001). The serum levels of IL-1β, IL-6, and TNF-α were found significantly decreased after treatment in the effective group (p<.05). The logistic regression showed that the levels of IL-6 TNF-α and AH were significant predictor of outcome.Conclusions: Our results demonstrated that PKP can reduce the serum levels of IL-6, IL-1β, and TNF-α, moreover, the IL-6, TNF-α, and AH were significant predictors of outcome.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch, Shanghai, PR China
| | - Yanchun Xu
- Department of Pathology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Weiwei Lu
- Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Fengbin Sun
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch, Shanghai, PR China
| | - Hongbo Li
- The First Department of General Surgery, Qingdao Municipal Hospital Qingdao, Qingdao, PR China
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19
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Chen J, Xu C, Yu J. Vesselplasty for the treatment of osteoporotic vertebral compression fractures with peripheral wall damage: a retrospective study. Br J Neurosurg 2024; 38:272-276. [PMID: 33319625 DOI: 10.1080/02688697.2020.1862054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The clinical efficacy of vertebroplasty and kyphoplasty treating osteoporotic vertebral compression fractures (OVCF) has been widely recognized in recent years. However, there are also disadvantages of bone cement leakage (BCL), limited correction of kyphosis and recovery of vertebral height. Nowadays, in view of these shortcomings, vesselplasty has been widely used in clinical practice. The objective of this study is to assess its clinical effect and application value for the treatment of OVCF with peripheral wall damage. METHODS 62 patients (70 vertebrae) treated for OVCF with peripheral wall damage using vesselplasty retrospectively reviewed. The data collection included operation time, volume of bone cement, relevant surgical complications, visual analog scale (VAS), Oswestry disability index (ODI), vertebral body height and kyphosis Cobb angle. RESULTS The volume of bone cement was 3-8 (5.3 ± 1.3) ml. There were 3 vertebrae of BCL (4.3%). VAS and ODI at different time points after operation were decreased compared with before operation (all p < 0.05). There were no statistical differences between VAS or ODI at different postoperative time points (p > 0.05). Vertebral body height and Cobb angle at different time points after operation were improved compared with before operation (all p < 0.05). There were no statistical differences between vertebral body height or Cobb angle at different postoperative time points (all p > 0.05). CONCLUSIONS Vesselplasty may reduce the risk of BCL and better control the dispersion of bone cement in the treatment of OVCF. It relieves pain, restores vertebral body height and corrects kyphosis, especially in OVCF with peripheral wall damage. Therefore, vesselplasty is safe and worthy of clinical application.
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Affiliation(s)
- Jiguang Chen
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China
| | - Chongqing Xu
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiangming Yu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China
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20
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Polzer C, Yilmaz E, Meyer C, Jang H, Jansen O, Lorenz C, Bürger C, Glüer CC, Sedaghat S. AI-based automated detection and stability analysis of traumatic vertebral body fractures on computed tomography. Eur J Radiol 2024; 173:111364. [PMID: 38364589 DOI: 10.1016/j.ejrad.2024.111364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/29/2023] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE We developed and tested a neural network for automated detection and stability analysis of vertebral body fractures on computed tomography (CT). MATERIALS AND METHODS 257 patients who underwent CT were included in this Institutional Review Board (IRB) approved study. 463 fractured and 1883 non-fractured vertebral bodies were included, with 190 fractures unstable. Two readers identified vertebral body fractures and assessed their stability. A combination of a Hierarchical Convolutional Neural Network (hNet) and a fracture Classification Network (fNet) was used to build a neural network for the automated detection and stability analysis of vertebral body fractures on CT. Two final test settings were chosen: one with vertebral body levels C1/2 included and one where they were excluded. RESULTS The mean age of the patients was 68 ± 14 years. 140 patients were female. The network showed a slightly higher diagnostic performance when excluding C1/2. Accordingly, the network was able to distinguish fractured and non-fractured vertebral bodies with a sensitivity of 75.8 % and a specificity of 80.3 %. Additionally, the network determined the stability of the vertebral bodies with a sensitivity of 88.4 % and a specificity of 80.3 %. The AUC was 87 % and 91 % for fracture detection and stability analysis, respectively. The sensitivity of our network in indicating the presence of at least one fracture / one unstable fracture within the whole spine achieved values of 78.7 % and 97.2 %, respectively, when excluding C1/2. CONCLUSION The developed neural network can automatically detect vertebral body fractures and evaluate their stability concurrently with a high diagnostic performance.
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Affiliation(s)
- Constanze Polzer
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Eren Yilmaz
- Section Biomedical Imaging, Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Computer Science, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany
| | - Carsten Meyer
- Department of Computer Science, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany; Department of Computer Science, Faculty of Engineering, Kiel University, Kiel, Germany
| | - Hyungseok Jang
- Department of Radiology, University of California San Diego, San Diego, USA
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | - Claus-Christian Glüer
- Section Biomedical Imaging, Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sam Sedaghat
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
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21
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Ruitenbeek HC, Oei EHG, Schmahl BL, Bos EM, Verdonschot RJCG, Visser JJ. Towards clinical implementation of an AI-algorithm for detection of cervical spine fractures on computed tomography. Eur J Radiol 2024; 173:111375. [PMID: 38377894 DOI: 10.1016/j.ejrad.2024.111375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Artificial intelligence (AI) applications can facilitate detection of cervical spine fractures on CT and reduce time to diagnosis by prioritizing suspected cases. PURPOSE To assess the effect on time to diagnose cervical spine fractures on CT and diagnostic accuracy of a commercially available AI application. MATERIALS AND METHODS In this study (June 2020 - March 2022) with historic controls and prospective evaluation, we evaluated regulatory-cleared AI-software to prioritize cervical spine fractures on CT. All patients underwent non-contrast CT of the cervical spine. The time between CT acquisition and the moment the scan was first opened (DNT) was compared between the retrospective and prospective cohorts. The reference standard for determining diagnostic accuracy was the radiology report created in routine clinical workflow and adjusted by a senior radiologist. Discrepant cases were reviewed and clinical relevance of missed fractures was determined. RESULTS 2973 (mean age, 55.4 ± 19.7 [standard deviation]; 1857 men) patients were analyzed by AI, including 2036 retrospective and 938 prospective cases. Overall prevalence of cervical spine fractures was 7.6 %. The DNT was 18 % (5 min) shorter in the prospective cohort. In scans positive for cervical spine fracture according to the reference standard, DNT was 46 % (16 min) shorter in the prospective cohort. Overall sensitivity of the AI application was 89.8 % (95 % CI: 84.2-94.0 %), specificity was 95.3 % (95 % CI: 94.2-96.2 %), and diagnostic accuracy was 94.8 % (95 % CI: 93.8-95.8 %). Negative predictive value was 99.1 % (95 % CI: 98.5-99.4 %) and positive predictive value was 63.0 % (95 % CI: 58.0-67.8 %). 22 fractures were missed by AI of which 5 required stabilizing therapy. CONCLUSION A time gain of 16 min to diagnosis for fractured cases was observed after introducing AI. Although AI-assisted workflow prioritization of cervical spine fractures on CT shows high diagnostic accuracy, clinically relevant cases were missed.
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Affiliation(s)
- Huibert C Ruitenbeek
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Edwin H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Bart L Schmahl
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Eelke M Bos
- Department of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Rob J C G Verdonschot
- Emergency Department, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Jacob J Visser
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
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22
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Dibs K, Facer B, Mageswaran P, Raval R, Thomas E, Gogineni E, Beyer S, Pan J, Klamer B, Ayan A, Bourekas E, Boulter D, Fetko N, Cochran E, Zoller I, Chakravarthy V, Tili E, Elder JB, Lonser R, Elguindy A, Soghrati S, Marras W, Grecula J, Chakravarti A, Palmer J, Blakaj DM. Vertebral Compression Fracture After Spine Stereotactic Body Radiotherapy: The Role of Vertebral Endplate Disruption. Neurosurgery 2024; 94:797-804. [PMID: 37902322 DOI: 10.1227/neu.0000000000002742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/13/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Vertebral compression fracture (VCF) is a common, but serious toxicity of spinal stereotactic body radiotherapy (SBRT). Several variables that place patients at high risk of VCF have previously been identified, including advanced Spinal Instability Neoplastic Score (SINS), a widely adopted clinical decision criterion to assess spinal instability. We examine the role of tumoral endplate (EP) disruption in the risk of VCF and attempt to incorporate it into a simple risk stratification system. METHODS This study was a retrospective cohort study from a single institution. Demographic and treatment information was collected for patients who received spinal SBRT between 2013 and 2019. EP disruption was noted on pre-SBRT computed tomography scan. The primary end point of 1-year cumulative incidence of VCF was assessed on follow-up MRI and computed tomography scans at 3-month intervals after treatment. RESULTS A total of 111 patients were included. The median follow-up was 18 months. Approximately 48 patients (43%) had at least one EP disruption. Twenty patients (18%) experienced a VCF at a median of 5.2 months from SBRT. Patients with at least one EP disruption were more likely to experience VCF than those with no EP disruption (29% vs 6%, P < .001). A nomogram was created using the variables of EP disruption, a SINS of ≥7, and adverse histology. Patients were stratified into groups at low and high risk of VCF, which were associated with 2% and 38% risk of VCF ( P < .001). CONCLUSION EP disruption is a novel risk factor for VCF in patients who will undergo spinal SBRT. A simple nomogram incorporating EP disruption, adverse histology, and SINS score is effective for quickly assessing risk of VCF. These data require validation in prospective studies and could be helpful in counseling patients regarding VCF risk and referring for prophylactic interventions in high-risk populations.
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Affiliation(s)
- Khaled Dibs
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Benjin Facer
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Prasath Mageswaran
- The Spine Research Institute, College of Engineering, The Ohio State University, Columbus , Ohio , USA
| | - Raju Raval
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Evan Thomas
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Emile Gogineni
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Sasha Beyer
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Jeff Pan
- Department of Biostatistics, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Brett Klamer
- Department of Biostatistics, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Ahmet Ayan
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Eric Bourekas
- Department of Radiology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Daniel Boulter
- Department of Radiology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Nicholas Fetko
- Department of Radiology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Eric Cochran
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Ian Zoller
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Vikram Chakravarthy
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Esmerina Tili
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - J Bradley Elder
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Russel Lonser
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Ahmed Elguindy
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Soheil Soghrati
- The Spine Research Institute, College of Engineering, The Ohio State University, Columbus , Ohio , USA
| | - William Marras
- The Spine Research Institute, College of Engineering, The Ohio State University, Columbus , Ohio , USA
| | - John Grecula
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Arnab Chakravarti
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Joshua Palmer
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
| | - Dukagjin M Blakaj
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus , Ohio , USA
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23
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Huneidi M, Bailly N, Farah K, May A, Arnoux PJ, Fuentes S. Iatrogenic vertebral fracture in ankylosed spine during liver transplantation: a case report and biomechanical study using finite element method. Eur Spine J 2024; 33:1332-1339. [PMID: 38172415 DOI: 10.1007/s00586-023-08103-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/31/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE The occurrence of an iatrogenic vertebral fracture during non-spinal digestive surgery is an exceptional event that has not been previously documented. Our study aims to explain the occurrence of this fracture from a biomechanical perspective, given its rarity. Using a finite element model of the spine, we will evaluate the strength required to induce a vertebral fracture through a hyperextension mechanism, considering the structure of the patient's spine, whether it is ossified or healthy. METHODS A 70-year-old patient was diagnosed T12 fracture during a liver transplantation on ankylosed spine. We use a finite element model of the spine. Different mechanical properties were applied to the spine model: first to a healthy spine, the second to a osteoporotic ossified spine. The displacement and force imposed at the Sacrum, the time and location of fractures initiation were recorded and compared between the two spine conditions. RESULTS A surgical treatment is done associating decompression with posterior fixation. After biomechanical study, we found that the fracture initiation occurred for the ossified spine after a sacrum displacement of 29 mm corresponding to an applied force of 65 N. For the healthy spine it occurred at a sacrum displacement of 52 mm corresponding to an applied force of 350 N. CONCLUSION The force required to produce a type B fracture in an ankylosed spine is 5 times less than in a healthy spine. These data enable us to propose several points of management to avoid unexpected complications with ankylosed spines during surgical procedures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Maxime Huneidi
- Département de Chirurgie Rachidienne, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, CHU Bordeaux, France.
| | - Nicolas Bailly
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR- Université de la Méditerranée, 13916, Marseille Cedex 20, France
| | - Kaissar Farah
- Département de Neurochirurgie, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Adrien May
- Département de Neurochirurgie, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Pierre-Jean Arnoux
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR- Université de la Méditerranée, 13916, Marseille Cedex 20, France
| | - Stéphane Fuentes
- Département de Neurochirurgie, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille, France
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24
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Sarigul B, Ogrenci A, Yilmaz M, Koban O, Mammadov M, Dalbayrak S. Sacral insufficiency fracture: a single-center experience of 185 patients with a minimum 5-year follow-up. Eur Spine J 2024; 33:1511-1517. [PMID: 37955749 DOI: 10.1007/s00586-023-08027-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/29/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Sacral insufficiency fracture (SIF) is a commonly underdiagnosed etiology of back pain, especially in the geriatric and osteoporotic population. In this clinical study, we present our experience of 185 patients who were diagnosed with SIF and managed either with conservative or surgical treatment with a minimum 5-year follow-up. MATERIALS AND METHOD Patients who were diagnosed with SIF, managed either conservatively or surgically, and had a minimum 5-year follow-up medical record were included in this study. CT scans and MR imaging including coronal STIR sequence were obtained from all. Bone densitometry (DEXA) was performed to detect accompanying osteopenia or osteoporosis. Patients were treated either conservatively or surgically. VAS and ODI scores were evaluated prior to the treatment and 1st day, 10th day, 3rd month, and 1st year postoperatively. RESULTS The mean age of 185 patients was 69.2 and the mean follow-up period was 7.23 years (range: 5-11 years). 46 (24.9%) patients had a previous spinal or spinopelvic surgery and spinal instrumentation was implemented in 22(11.89%) of them. The time interval between the fusion surgery and the diagnosis of SIF was approximately 9.48 weeks. The fracture line could be detected with the MRI in 164 patients and with the CT in 177 patients. The fracture was bilateral in 120 (64.8%) patients. 102 patients were treated conservatively, and 83 received sacroplasty. VAS and ODI scores showed better improvement in pain and functionality in the surgical management group than in the conservative management group. CONCLUSION SIF should be considered in the differential diagnosis of back and pelvic pain, especially in elderly and osteoporotic patients. MRI with coronal STIR imaging should be a standard protocol for patients with a risk of SIF. Our results show that sacroplasty provides better and faster pain relief and recovery than conservative management.
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Affiliation(s)
- Buse Sarigul
- Department of Neurosurgery, Medicana International Atasehir Hospital, Istanbul, Turkey.
| | - Ahmet Ogrenci
- Department of Neurosurgery, Medicana International Atasehir Hospital, Istanbul, Turkey
| | - Mesut Yilmaz
- Department of Neurosurgery, Neurospinal Academy, Istanbul, Turkey
| | - Orkun Koban
- Department of Neurosurgery, Lokman Hekim Hospital, Istanbul, Turkey
| | - Mazhar Mammadov
- Department of Neurosurgery, Lokman Hekim Hospital, Istanbul, Turkey
| | - Sedat Dalbayrak
- Department of Neurosurgery, Medicana International Atasehir Hospital, Istanbul, Turkey
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25
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Kang KH, Seok SY, Cho JH. Concurrently Occurring Spinal Cord Cross-Section and Aortic Injury After a Chalk-Stick Fracture and Dislocation in Patient with Ankylosing Spondylitis: Clinical Image. World Neurosurg 2024; 184:149-151. [PMID: 38278209 DOI: 10.1016/j.wneu.2024.01.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
A 74-year-old woman with ankylosing spondylitis presented with back pain and complete paraplegia after a fall. A radiologic finding of a bamboo spine, a characteristic feature of ankylosing spondylitis, was observed on computed tomography, along with a fracture-dislocation involving T10 and T11 (chalk-stick fracture) and compression of the descending thoracic aorta due to the caudal bony column. The patient underwent an open reduction and T8-L3 posterior fusion in the operating room. A complete cross-section of the spinal cord was observed during surgery. Post operation, a decrease in blood pressure led to a thoracotomy and thoracic endovascular aortic repair due to a crack in the descending aorta wall. Thoracolumbar fracture-dislocations, particularly in patients with ankylosing spondylitis, are characterized by instability and can be further complicated by concurrent vascular and spinal cord injuries. It is crucial therefore to recognize the potential for vascular and spinal cord injuries early on in such cases.
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Affiliation(s)
- Kyun Ho Kang
- Departments of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Sang Yun Seok
- Departments of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea.
| | - Jae Hwan Cho
- Departments of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Marie-Hardy L, Mohsinaly Y, Pietton R, Bonaccorsi R, Vialle R, Pascal-Moussellard H. Defining threshold for sagittal correction in lumbar fractures. Eur Spine J 2024; 33:1550-1555. [PMID: 38315226 DOI: 10.1007/s00586-024-08138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/04/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Surgical indications for thoraco-lumbar fractures are driven both by neurological status, fractures instability and kyphotic deformity. Regarding kyphotic deformity, an angulation superior to 20° is considered by many surgeons as a surgical indication to reduce the disability induced by post-traumatic kyphosis. However, there is a lack of data reporting the ideal or theoretical lordosis that one must have in a particular lumbar segment on CT-scan. The main goal of this study was to determine the mean value for segmental lumbar lordosis according to pelvic incidence (PI) on a cohort of normal subjects. METHODS The consecutive CT-scan of 171 normal adult subjects were retrospectively analyzed. The PI and the segmental lordosis (L4S1, L3L5, L2L4, L3L1, L2T12 and T11-L1) were measured on all CT-scan. The mean values were calculated for the global cohort and a sub-group analysis according to IP ranges (< 45°, 45 < IP < 60° and > 60°) was performed. RESULTS The mean angular values for the whole cohort were IP: 54, 9°; L4S1: - 38, 1°; L3L5: - 30, 6°; L2L4: - 14, 1°; L1L3: - 4, 9°; T12L2: + 1, 9° and T11L1: + 5, 4°. The segmental values vary significatively with PI ranges, as for L3L5: - 26, 8° (PI < 45°); - 30° (45 < PI < 60°) and - 35, 1° (PI > 60°). CONCLUSION These results provide a referential of theoretical values of segmental lordosis according to PI. This abacus may help spinal surgeon in their decision-making process regarding lumbar fractures, to determine the amount of sagittal correction needed, according to the PI range, to be adapted to the sagittal morphology of the patient. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Laura Marie-Hardy
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France.
| | - Yann Mohsinaly
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
| | - Raphaël Pietton
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
| | - Raphaël Bonaccorsi
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
| | - Raphaël Vialle
- Pediatric Orthopaedic Department, Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France
| | - Hugues Pascal-Moussellard
- Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France
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Tang B, Liu L, Cui L, Wang Y, Yuan X, Liu Y, Chen X. Analysis of adjacent vertebral fracture after percutaneous vertebroplasty: do radiological or surgical features matter? Eur Spine J 2024; 33:1524-1532. [PMID: 38315225 DOI: 10.1007/s00586-023-08092-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE To report the incidence and risk factors of adjacent vertebral fracture (AVF) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCFs). We focused to investigate effect of radiological or surgical features on AVF. METHODS All patients with OVCFs who were treated with PVP between January 2016 and December 2019 were retrospectively reviewed. Patients were followed up at least 12 months after procedure according to treatment protocol. AVF was defined as postoperatively recurrent intractable back pain and subsequently presence of fracture on magnetic resonance imaging (MRI) in adjacent levels. Clinical, radiological, and surgical factors potentially affecting occurrence of AVF were recorded and analyzed using univariate and multivariate analysis. RESULTS Totally, 1077 patients with 1077 fractured vertebrae who underwent PVP were enrolled in the study, after inclusion and exclusion criteria were met. Mean follow-up time was 24.3 ± 11.9 months (range, 12-59 months). AVF was identified in 98 (9.1%) patients. Univariate analysis showed that seven significant factors related to AVF were older age, non-traumatic fracture, cortical disruption on anterior wall, cortical disruption on lateral wall, basivertebral foramen, type-B leakage and type-C leakage. In multivariate analysis, two clinical factors, older age (P = 0.031) and non-traumatic fracture (P = 0.002), were significantly associated with AVF. However, any radiological or surgical factor did not reach significance in final model analysis. CONCLUSIONS Incidence of AVF after PVP in patients with OVCFs was 9.1% (98/1077). Older age and non-traumatic fracture were two clinical risk factors for AVF. Neither radiological nor surgical feature was significantly correlated with AVF.
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Affiliation(s)
- Benqiang Tang
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China
| | - Liang Liu
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China
| | - Libin Cui
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China
| | - Yanhui Wang
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China
| | - Xin Yuan
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China
| | - Yadong Liu
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China
| | - Xueming Chen
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China.
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Umeda A, Murata K, Murotani Y, Fujii T, Onishi A, Murakami K, Onizawa H, Otsuki B, Shimizu T, Tanaka M, Morinobu A, Matsuda S. Low Hounsfield unit values on computed tomography as a potential predictor of vertebral fracture in patients with rheumatoid arthritis: The KURAMA cohort study. Int J Rheum Dis 2024; 27:e15146. [PMID: 38661342 DOI: 10.1111/1756-185x.15146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/12/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Hounsfield units (HU) measured using computed tomography (CT) have gained considerable attention for the detection of osteoporosis. This study aimed to investigate whether opportunistic CT could predict vertebral fractures in patients with rheumatoid arthritis (RA). METHODS A total of 233 patients with RA who underwent chest CT were included in this study. The HU values of the anterior 1/3 of the vertebral bodies based on the sagittal plane at T11-L2 after reconstruction were measured. The incidence of vertebral fractures was investigated with respect to the HU value. RESULTS Vertebral fractures were identified in 32 patients during a mean follow-up period of 3.8 years. In patients who experienced vertebral fractures within 2 years of CT imaging, the HU values of the vertebral bodies (T11-L2) were lower than those in patients who did not experience fractures. Receiver operating characteristic curve analysis identified that a T11 HU value of <125 was a risk factor for vertebral fracture within 2 years. Multivariate analysis showed that a T11 HU value of <125 and the existence of prevalent vertebral fractures were significant risk factors for fracture. CONCLUSION HU measurements of the anterior 1/3 of the vertebral body are a potential predictor for vertebral fractures in patients with RA.
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Affiliation(s)
- Akane Umeda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiki Murotani
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayuki Fujii
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Onishi
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kosaku Murakami
- Division of Clinical Immunology and Cancer Immunotherapy, Center for Cancer Immunotherapy and Immunobiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideo Onizawa
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Yokoyama K, Ikeda N, Tanaka H, Ito Y, Sugie A, Yamada M, Wanibuchi M, Kawanishi M. Changes in spinal sagittal balance after a new osteoporotic vertebral compression fracture. Osteoporos Int 2024; 35:645-651. [PMID: 38108858 DOI: 10.1007/s00198-023-06976-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023]
Abstract
We conduct a longitudinal study to examine how new VCF alter spinal sagittal balance. New VCF increased SVA by an average of 2.8 cm. Sagittal balance deteriorates as a VCF develops in the lower lumbar spine. A new fracture below L1 increased the relative risk of a deterioration of sagittal balance 2.9-fold compared to one above Th12. PURPOSE Studies on the relationship between osteoporotic vertebral fractures and spinal sagittal balance have all been limited to cross-sectional studies. The aim of this study is to conduct a longitudinal study to examine how new vertebral compression fracture (VCF) alter spinal sagittal balance. METHODS Subjects were patients undergoing periodic examinations after treatment of a vertebral fracture or lumbar spinal canal stenosis. Forty patients who developed a new VCF were included in this study. Full-spine standing radiographs were compared before and after the fracture to examine changes in spinopelvic parameters and factors determining the changes in sagittal balance. RESULTS The mean age of the patients was 79.0 years. The mean interval between pre- and post-fracture radiographs was 22.7 months, and the mean time between development of a fracture and post-fracture radiographs was 4.6 months. After a fracture, sagittal vertical axis (SVA) increased an average of 2.78 cm and spino-sacral angle (SSA) decreased an average of 5.3°. Both ⊿SVA and ⊿SSA were not related to pre-fracture parameters. The wedge angle of the fractured vertebra was not related to changes in sagittal balance. ⊿SVA increased markedly in patients with a fracture of the lower lumbar vertebrae. receiver operating characteristic analysis revealed that the relative risk of a deterioration of sagittal balance was 2.9 times higher for a new fracture below L1 than for a fracture above Th12. CONCLUSION New VCF increased SVA by an average of 2.8 cm. Sagittal balance deteriorates as a new fracture develops in the lower lumbar spine. Early intervention in osteoporosis is vital for the elderly.
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Affiliation(s)
- Kunio Yokoyama
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan.
| | - Naokado Ikeda
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan
| | - Hidekazu Tanaka
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan
| | - Yutaka Ito
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan
| | - Akira Sugie
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan
| | - Makoto Yamada
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Masahiro Kawanishi
- Department of Neurosurgery, Takeda General Hospital, 28-1, Ishidamoriminami-Machi, Fushimi, Kyoto, 601-1495, Japan
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Vißmann S, Schöttes P, Topcuoglu F, Strohmann T, Stahl JP, Rohde S. [Precision and safety of positioning pedicle screws in the thoracic and lumbar spine using a hand-guided aiming sleeve : A CT control study]. Unfallchirurgie (Heidelb) 2024; 127:297-304. [PMID: 37989763 DOI: 10.1007/s00113-023-01392-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND For the implantation of pedicle screws, navigation-supported systems are nowadays used more and more to avoid screw misalignment by making the direction of the screw more predictable. OBJECTIVE Examination of the precision after instrumentation of the pedicle screw with the hand-guided aiming sleeve. The aim was to verify that the implementation of the pedicle screws is plannable and precise by using 2D X‑ray only. METHOD This retrospective study analyzed 27 consecutive trauma patients (17-84 years, 13f/14m) with vertebral body fractures. The position and precision of 108 screws, implanted using the hand-guided aiming sleeve was investigated. To determine the position the actual course of the screws was examined using the postoperative 3D CT data set (GE Optima 540, General Electric Company Boston, MA, USA; slice thickness 1.25 mm). The screws were then compared to the previously defined ideal position of the tip of the screw. In addition to the absolute and relative deviation from the ideal target point, the convergence angle and the parallelism to the cover plate were determined. RESULTS Of 108 implanted pedicle screws, 90 (83%) were within target. The remaining 18 (17%) represented a clinically irrelevant screw deviation: A lateral deviation was found in 17 pedicle screws (16%) and a medial deviation in 1 (1%). The average deviation from the ideal target point in the vertebral body was 2.3 mm ventrally with a standard deviation of ± 2.3 mm. No screw misalignment or pedicle perforation was found. CONCLUSION The transcutaneous implantation of pedicle screws with a hand-guided aiming sleeve in the thoracic and lumbar spine represents a safe and precise procedure. The risk of misalignment needing a revision is lower compared to other methods of navigated screw implantation reported in the literature [1-6]. A CT-based preliminary planning is not necessary. The method is economical, special technical equipment is not required.
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Affiliation(s)
- Silke Vißmann
- Klinik für Radiologie und Neuroradiologie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Dortmund, Deutschland.
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Münsterstraße 240, 44137, Dortmund, Deutschland.
| | - Philippus Schöttes
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Münsterstraße 240, 44137, Dortmund, Deutschland
| | - Fatma Topcuoglu
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Münsterstraße 240, 44137, Dortmund, Deutschland
| | - Thorsten Strohmann
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Münsterstraße 240, 44137, Dortmund, Deutschland
| | - Jens-Peter Stahl
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Münsterstraße 240, 44137, Dortmund, Deutschland
| | - Stefan Rohde
- Klinik für Radiologie und Neuroradiologie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Dortmund, Deutschland
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Herren C, Jarvers JS, Jung MK, Blume C, Meinig H, Ruf M, Weiß T, Rüther H, Welk T, Badke A, Gonschorek O, Heyde CE, Kandziora F, Knop C, Kobbe P, Scholz M, Siekmann H, Spiegl U, Strohm P, Strüwind C, Matschke S, Disch AC, Kreinest M. Paediatric spine injuries in the thoracic and lumbar spine-results of the German multicentre CHILDSPINE study. Eur Spine J 2024; 33:1574-1584. [PMID: 37466720 DOI: 10.1007/s00586-023-07822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Paediatric thoracolumbar spine injuries are rare, and meaningful epidemiological data are lacking. OBJECTIVES The aim of this study was to provide epidemiological data for paediatric patients with thoracolumbar spinal trauma in Germany with a view to enhancing future decision-making in relation to the diagnostics and treatment of these patients. MATERIALS AND METHODS A retrospective multicentre study includes patients up to 16 years of age who were suffering from thoracolumbar spine injuries who had been treated in six German spine centres between 01/2010 and 12/2016. The clinical database was analysed for patient-specific data, trauma mechanisms, level of injury, and any accompanying injuries. Diagnostic imaging and subsequent treatment were investigated. Patients were divided into three age groups for further evaluation: age group I (0-6 years), age group II (7-9 years) and age group III (10-16 years). RESULTS A total of 153 children with 345 thoracolumbar spine injuries met the inclusion criteria. The mean age at the time of hospitalization due to the injury was 12.9 (± 3.1) years. Boys were likelier to be affected (1:1.3). In all age groups, falls and traffic accidents were the most common causes of thoracolumbar spine injuries. A total of 95 patients (62.1%) were treated conservatively, while 58 (37.9%) of the children underwent surgical treatment. Minimally invasive procedures were the most chosen procedures. Older children and adolescents were likelier to suffer from higher-grade injuries according to the AOSpine classification. The thoracolumbar junction (T11 to L2) was the most affected level along the thoracolumbar spine (n = 90). Neurological deficits were rarely seen in all age groups. Besides extremity injuries (n = 52, 30.2%), head injuries represented the most common accompanying injuries (n = 53, 30.8%). Regarding spinal injuries, most of the patients showed no evidence of complications during their hospital stay (96.7%). CONCLUSIONS The thoracolumbar junction was more frequently affected in older children and adolescents. The majority of thoracolumbar spinal column injuries were treated conservatively. Nevertheless, 37.9% of hospitalized children had to be treated surgically, and there was an acceptable complication rate for the surgeries that were performed.
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Affiliation(s)
- Christian Herren
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Jan-Sven Jarvers
- Universitätsklinikum Leipzig, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Leipzig, Germany
| | - Matthias K Jung
- BG Klinik Ludwigshafen, Zentrum für Wirbelsäulenchirurgie, Ludwigshafen Am Rhein, Germany
| | - Christian Blume
- Uniklinik RWTH Aachen, Klinik für Neurochirurgie, Aachen, Germany
| | - Holger Meinig
- SRH Klinikum Karlsbad-Langensteinbach, Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, Karlsbad, Germany
| | - Michael Ruf
- SRH Klinikum Karlsbad-Langensteinbach, Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, Karlsbad, Germany
| | - Thomas Weiß
- BG Unfallklinik Murnau, Abteilung Wirbelsäulenchirurgie, Staffelsee, Germany
| | - Hauke Rüther
- Universitätsmedizin Göttingen, Zentrum für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Göttingen, Germany
| | - Thomas Welk
- SRH Klinikum Karlsbad-Langensteinbach, Abteilung für Radiologie und Neuroradiologie, Karlsbad, Germany
| | - Andreas Badke
- BG Klinik Tübingen, Abteilung für Wirbelsäulenchirurgie, Tübingen, Germany
| | - Oliver Gonschorek
- BG Unfallklinik Murnau, Abteilung Wirbelsäulenchirurgie, Staffelsee, Germany
| | - Christoph E Heyde
- Universitätsklinikum Leipzig, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Leipzig, Germany
| | - Frank Kandziora
- BG Unfallklinik Frankfurt, Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt Am Main, Germany
| | - Christian Knop
- Klinikum Stuttgart, Klinik für Unfallchirurgie und Orthopädie, Stuttgart, Germany
| | - Philipp Kobbe
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Matti Scholz
- BG Unfallklinik Frankfurt, Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt Am Main, Germany
| | - Holger Siekmann
- Ameos Klinik Halberstadt, Klinik für Unfall, Hand- und Wiederherstellungschirurgie, Halberstadt, Germany
| | - Ulrich Spiegl
- Universitätsklinikum Leipzig, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Leipzig, Germany
| | - Peter Strohm
- Klinikum Bamberg, Klinik für Orthopädie und Unfallchirurgie, Bamberg, Germany
| | - Christoph Strüwind
- BG Unfallklinik Murnau, Abteilung Wirbelsäulenchirurgie, Staffelsee, Germany
| | - Stefan Matschke
- ATOS Klinik Heidelberg, Praxis für Wirbelsäulenchirurgie, Heidelberg, Germany
| | - Alexander C Disch
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, UniversitätsWirbelsäulenzentrum (UCSC), UniversitätsCentrum für Orthopädie, Unfall- and Plastische Chirurgie, Dresden, Germany
| | - Michael Kreinest
- BG Klinik Ludwigshafen, Zentrum für Wirbelsäulenchirurgie, Ludwigshafen Am Rhein, Germany
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Zhang J, Xia L, Liu J, Niu X, Tang J, Xia J, Liu Y, Zhang W, Liang Z, Zhang X, Tang G, Zhang L. Exploring deep learning radiomics for classifying osteoporotic vertebral fractures in X-ray images. Front Endocrinol (Lausanne) 2024; 15:1370838. [PMID: 38606087 PMCID: PMC11007145 DOI: 10.3389/fendo.2024.1370838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Purpose To develop and validate a deep learning radiomics (DLR) model that uses X-ray images to predict the classification of osteoporotic vertebral fractures (OVFs). Material and methods The study encompassed a cohort of 942 patients, involving examinations of 1076 vertebrae through X-ray, CT, and MRI across three distinct hospitals. The OVFs were categorized as class 0, 1, or 2 based on the Assessment System of Thoracolumbar Osteoporotic Fracture. The dataset was divided randomly into four distinct subsets: a training set comprising 712 samples, an internal validation set with 178 samples, an external validation set containing 111 samples, and a prospective validation set consisting of 75 samples. The ResNet-50 architectural model was used to implement deep transfer learning (DTL), undergoing -pre-training separately on the RadImageNet and ImageNet datasets. Features from DTL and radiomics were extracted and integrated using X-ray images. The optimal fusion feature model was identified through least absolute shrinkage and selection operator logistic regression. Evaluation of the predictive capabilities for OVFs classification involved eight machine learning models, assessed through receiver operating characteristic curves employing the "One-vs-Rest" strategy. The Delong test was applied to compare the predictive performance of the superior RadImageNet model against the ImageNet model. Results Following pre-training separately on RadImageNet and ImageNet datasets, feature selection and fusion yielded 17 and 12 fusion features, respectively. Logistic regression emerged as the optimal machine learning algorithm for both DLR models. Across the training set, internal validation set, external validation set, and prospective validation set, the macro-average Area Under the Curve (AUC) based on the RadImageNet dataset surpassed those based on the ImageNet dataset, with statistically significant differences observed (P<0.05). Utilizing the binary "One-vs-Rest" strategy, the model based on the RadImageNet dataset demonstrated superior efficacy in predicting Class 0, achieving an AUC of 0.969 and accuracy of 0.863. Predicting Class 1 yielded an AUC of 0.945 and accuracy of 0.875, while for Class 2, the AUC and accuracy were 0.809 and 0.692, respectively. Conclusion The DLR model, based on the RadImageNet dataset, outperformed the ImageNet model in predicting the classification of OVFs, with generalizability confirmed in the prospective validation set.
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Affiliation(s)
- Jun Zhang
- Department of Radiology, Shanghai Tenth People’s Hospital, Clinical Medical College of Nanjing Medical University, Shanghai, China
- Department of Radiology, Sir RunRun Hospital, Nanjing Medical University, Nanjing, China
| | - Liang Xia
- Department of Radiology, Sir RunRun Hospital, Nanjing Medical University, Nanjing, China
| | - Jiayi Liu
- Department of Radiology, Sir RunRun Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaoying Niu
- Department of Neonates, Dongfeng General Hospital of National Medicine, Hubei University of Medicine, Shiyan, China
| | - Jun Tang
- Department of Radiology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
| | - Jianguo Xia
- Department of Radiology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
| | - Yongkang Liu
- Department of Radiology, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Weixiao Zhang
- Department of Radiology, Sir RunRun Hospital, Nanjing Medical University, Nanjing, China
| | - Zhipeng Liang
- Department of Radiology, Sir RunRun Hospital, Nanjing Medical University, Nanjing, China
| | - Xueli Zhang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guangyu Tang
- Department of Radiology, Shanghai Tenth People’s Hospital, Clinical Medical College of Nanjing Medical University, Shanghai, China
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lin Zhang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
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Furukawa M, Fujiyoshi K, Kajikawa K, Kobayashi Y, Konomi T, Yato Y. Surgical outcomes of anterior column reconstruction for spinal fractures caused by minor trauma-preoperative examination of the number of intervertebral bone bridges is key to obtaining good bone fusion. BMC Musculoskelet Disord 2024; 25:216. [PMID: 38481188 PMCID: PMC10938728 DOI: 10.1186/s12891-024-07326-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/01/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND To achieve good bone fusion in anterior column reconstruction for vertebral fractures, not only bone mineral density (BMD) and bone metabolism markers but also lever arms due to bone bridging between vertebral bodies should be evaluated. However, until now, no lever arm index has been devised. Therefore, we believe that the maximum number of vertebral bodies that are bony and cross-linked with the contiguous adjacent vertebrae (maxVB) can be used as a measure for lever arms. The purpose of this study is to investigate the surgical outcomes of anterior column reconstruction for spinal fractures and to determine the effect of bone bridging between vertebral bodies on the rate of bone fusion using the maxVB as an indicator of the length of the lever arm. METHODS The clinical data of 81 patients who underwent anterior column reconstruction for spinal fracture between 2014 and 2022 were evaluated. The bone fusion rate, back pain score, between the maxVB = 0 and the maxVB ≥ 2 patients were adjusted for confounding factors (age, smoking history, diabetes mellitus history, BMD, osteoporosis drugs, surgical technique, number of fixed vertebrae, materials used for the anterior props, etc.) and analysed with multivariate or multiple regression analyses. The bone healing rate and incidence of postoperative back pain were compared among the three groups (maxVB = 0, 2≦maxVB≦8, maxVB ≧ 9) and divided by the maxVB after adjusting for confounding factors. RESULTS Patients with a maxVB ≥ 2 had a significantly higher bone fusion rate (p < 0.01) and postoperative back pain score (p < 0.01) than those with a maxVB = 0. Among the three groups, the bone fusion rate and back pain score were significantly higher in the 2≦maxVB≦8 group (p = 0.01, p < 0.01). CONCLUSIONS Examination of the maxVB as an indicator of the use of a lever arm is beneficial for anterior column reconstruction for vertebral fractures. Patients with no intervertebral bone bridging or a high number of bone bridges are in more need of measures to promote bone fusion than patients with a moderate number of bone bridges are.
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Affiliation(s)
- Mitsuru Furukawa
- Department of Orthopedic Surgery, NHO Murayama Medical Center, Tokyo, Japan.
- Institute of Murayama Medical Center, 2-37-11 Gakuen, Musashimurayamashi, Tokyo, 208-0011, Japan.
| | - Kanehiro Fujiyoshi
- Department of Orthopedic Surgery, NHO Murayama Medical Center, Tokyo, Japan
| | - Keita Kajikawa
- Department of Orthopedic Surgery, NHO Murayama Medical Center, Tokyo, Japan
| | - Yoshiomi Kobayashi
- Department of Orthopedic Surgery, NHO Murayama Medical Center, Tokyo, Japan
| | - Tsunehiko Konomi
- Department of Orthopedic Surgery, NHO Murayama Medical Center, Tokyo, Japan
| | - Yoshiyuki Yato
- Department of Orthopedic Surgery, NHO Murayama Medical Center, Tokyo, Japan
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Ikegami S, Uehara M, Tokida R, Nishimura H, Sakai N, Horiuchi H, Kato H, Takahashi J. Male-female disparity in clinical features and significance of mild vertebral fractures in community-dwelling residents aged 50 and over. Sci Rep 2024; 14:5602. [PMID: 38453997 PMCID: PMC10920731 DOI: 10.1038/s41598-024-56379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/05/2024] [Indexed: 03/09/2024] Open
Abstract
This investigation examined the clinical implications of mild vertebral fractures in older community-dwelling residents. Focusing on the locomotion health of older individuals, the earlier reported Obuse study enrolled 415 randomly sampled Japanese residents aged between 50 and 89 years, 411 of whom underwent X-ray evaluations for pre-existing vertebral fractures. A blinded assessment of vertebral fractures based on Genant's criteria was conducted on the T5-L5 spine for rating on a severity scale. Grade 1 mild fractures were not linked to age in males, but increased with aging in females. Female participants had fewer Grade 1 and 2 fractures (P = 0.003 and 0.035, respectively) but more Grade 3 fractures (P = 0.013) than did males independently of age (Grade 1, 2, and 3: 25%, 16%, and 9% in females and 40%, 22%, and 6% in males, respectively). Weak negative correlations were observed between the number of fractures and bone mineral density in females for all fracture grades (Spearman's rho: 0.23 to 0.36, P < 0.05). Our study showed that Grade 1 mild vertebral fractures in males lacked pathological significance, while in females they potentially indicated fragility fractures and were related to poor lumbopelvic alignment.
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Affiliation(s)
- Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
- Rehabilitation Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ryosuke Tokida
- Rehabilitation Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hikaru Nishimura
- Rehabilitation Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Noriko Sakai
- Department of Orthopaedic Surgery, New Life Hospital, 851 Obuse, Kamitakai-gun, Nagano, 381-0295, Japan
| | - Hiroshi Horiuchi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
- Rehabilitation Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Chou KN, Wang PW, Chung MH, Ju DT. Hybrid kyphoplasty with short-versus intermediate- and long-segment pedicle screw fixations for the management of thoracolumbar burst fractures. BMC Musculoskelet Disord 2024; 25:203. [PMID: 38454411 PMCID: PMC10919052 DOI: 10.1186/s12891-024-07320-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/28/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND This study aimed to determine if the hybrid short-segment (HSS) technique is a good alternative to the intermediate-segment (IS) and long-segment (LS) techniques in pedicle screw fixations for acute thoracolumbar burst fractures (TLBFs). METHODS In this retrospective evaluation, we examined 43 patients who underwent surgical treatments, including one- or two-level suprajacent (U) and infrajacent (L) pedicle screw fixations, for acute single-level TLBFs with neurological deficits between the T11 and L2 levels from July 2013 to December 2019. Among these patients, 15 individuals underwent HSS (U1L1), 12 received IS (U2L1), and 16 underwent LS (U2L2) fixations. Supplemental kyphoplasty of the fractured vertebral bodies was performed exclusively in the HSS group. Our analysis focused on assessing blood loss and surgical duration. Additionally, we compared postoperative thoracolumbar kyphotic degeneration using the data on Cobb angles on lateral radiographic images acquired at three time points (preoperatively, postoperative day 1, and follow-up). The end of follow-up was defined as the most recent postoperative radiographic image or implant complication occurrence. RESULTS Blood loss and surgical duration were significantly lower in the HSS group than in the IS and LS groups. Additionally, the HSS group exhibited the lowest implant complication rate (2/15, 13.33%), followed by the LS (6/16, 37.5%) and IS (8/12, 66.7%) group. Implant complications occurred at a mean follow-up of 7.5 (range: 6-9), 9 (range: 5-23), and 7 (range: 1-21) months in the HSS, IS, and LS groups. Among these implant complications, revision surgeries were performed in two patients in the HSS group, two in the IS group, and one in the LS group. One patient treated by HSS with balloon kyphoplasty underwent reoperation because of symptomatic cement leakage. CONCLUSIONS The HSS technique reduced intraoperative blood loss, surgical duration, and postoperative implant complications, indicating it is a good alternative to the IS and LS techniques for treating acute single-level TLBFs. This technique facilitates immediate kyphosis correction and successful maintenance of the corrected alignment within 1 year. Supplemental kyphoplasty with SpineJack® devices and high-viscosity bone cements for anterior reconstruction can potentially decrease the risk of cement leakage and related issues.
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Affiliation(s)
- Kuan-Nien Chou
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, 114, Taipei, Taiwan (R.O.C.)
| | - Peng-Wei Wang
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, 114, Taipei, Taiwan (R.O.C.)
| | - Ming-Hsuan Chung
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, 114, Taipei, Taiwan (R.O.C.)
| | - Da-Tong Ju
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, 114, Taipei, Taiwan (R.O.C.).
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Hohenleitner J, Saporito R, Hirsch M, Ravikumar V, Gawdi R, Taruvai V, Tufiarello A, Livingston DH, Bonne S. Straight Leg Raise Cannot Replace Computed Tomography in the Detection of Spinal Column Fractures. J Surg Res 2024; 295:699-704. [PMID: 38134740 DOI: 10.1016/j.jss.2023.11.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 11/10/2023] [Accepted: 11/18/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION An active straight leg raise (SLR) is a weight bearing test which assesses pain upon movement and a patient's ability to load their pelvis, lumbar, and thoracic spine. Since many stable patients undergo computed tomography (CT) scanning solely for spinal tenderness, our hypothesis is that performing active straight leg raising could effectively rule out lumbar and thoracic vertebral fractures. METHODS Blunt trauma patients ≥18 years of age with Glasgow Coma Scale 15 presenting in hemodynamically stable condition were screened. Patients remaining in the supine position were asked to perform SLR at 12, 18, and 24 inches above the bed. The patient's ability to raise the leg, baseline pain, and pain at each level were assessed. Patients also underwent standard CT scanning of the chest, abdomen and pelvis. The clinical examination results were then matched post hoc with the official radiology reports. RESULTS 99 patients were screened, 65 males and 34 females. Spinal fractures were present in 15/99 patients (16%). Mechanisms of injury included motor vehicle collision 51%, pedestrian struck 25%, fall1 9%, and other 4%. The median pain score of patients with and without significant spinal fractures at 12, 18, 24 inches was 7.5, 7, 6 and 5, 5, 4, respectively. At 24 inches, active SLR had sensitivity of 0.47, a specificity of 0.59, a positive predictive value of 0.17, and an negative predictive value of 0.86. CONCLUSIONS Although SLR has been discussed as a useful adjunct to secondary survey and physical exam following blunt trauma, its positive and more importantly negative predictive value are insufficient to rule out spinal column fractures. Liberal indications for CT based upon mechanism and especially pain and tenderness are necessary to identify all thoraco-lumbar spine fractures.
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Affiliation(s)
- Julien Hohenleitner
- Rutgers New Jersey Medical School, Newark, NJ; Donald and Barbara Zucker School of Medicine at Northwell Health (NSLIJ), Uniondale, NY.
| | | | | | | | - Rohin Gawdi
- Donald and Barbara Zucker School of Medicine at Northwell Health (NSLIJ), Uniondale, NY
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Ishizaki S, Furukawa K, Haruki K, Tsunematsu M, Shirai Y, Matsumoto M, Okui N, Onda S, Taniai T, Ikegami T. Prognostic significance of occult vertebral fracture in patients undergoing pancreatic resection for pancreatic cancer. Pancreatology 2024; 24:249-254. [PMID: 38218681 DOI: 10.1016/j.pan.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/17/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE The prognostic impact of occult vertebral fracture (OVF) in patients with malignancies is a new cutting edge in cancer research. This study was performed to analyze the prognostic impact of OVF after surgery for pancreatic cancer. METHODS This study involved 200 patients who underwent surgical treatment of pancreatic ductal adenocarcinoma. OVF was diagnosed by quantitative measurement using preoperative sagittal computed tomography image reconstruction from the 11th thoracic vertebra to the 5th lumbar vertebra. RESULTS OVF was diagnosed in 65 (32.5 %) patients. The multivariate analyses showed that male sex (p = 0.01), osteopenia (p < 0.01), OVF (p < 0.01), a carbohydrate antigen 19-9 level of ≥400 U/mL (p < 0.01), advanced stage of cancer (p < 0.01), and non-adjuvant chemotherapy (p = 0.02) were independent risk factors for overall survival. An age of ≥74 years (p < 0.01) and obstructive jaundice (p = 0.03) were independent risk factors for OVF. Furthermore, the combination of OVF and osteopenia further worsened disease-free survival and overall survival compared with osteopenia or OVF alone (p < 0.01; respectively). CONCLUSION Evaluation of preoperative OVF might be a useful prognostic indicator for patients with pancreatic ductal adenocarcinoma.
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Affiliation(s)
- Shunta Ishizaki
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kenei Furukawa
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Koichiro Haruki
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masashi Tsunematsu
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yoshihiro Shirai
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Michinori Matsumoto
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Norimitsu Okui
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shinji Onda
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tomohiko Taniai
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Toru Ikegami
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Foreman SC, Schinz D, El Husseini M, Goller SS, Weißinger J, Dietrich AS, Renz M, Metz MC, Feuerriegel GC, Wiestler B, Stahl R, Schwaiger BJ, Makowski MR, Kirschke JS, Gersing AS. Deep Learning to Differentiate Benign and Malignant Vertebral Fractures at Multidetector CT. Radiology 2024; 310:e231429. [PMID: 38530172 DOI: 10.1148/radiol.231429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Background Differentiating between benign and malignant vertebral fractures poses diagnostic challenges. Purpose To investigate the reliability of CT-based deep learning models to differentiate between benign and malignant vertebral fractures. Materials and Methods CT scans acquired in patients with benign or malignant vertebral fractures from June 2005 to December 2022 at two university hospitals were retrospectively identified based on a composite reference standard that included histopathologic and radiologic information. An internal test set was randomly selected, and an external test set was obtained from an additional hospital. Models used a three-dimensional U-Net encoder-classifier architecture and applied data augmentation during training. Performance was evaluated using the area under the receiver operating characteristic curve (AUC) and compared with that of two residents and one fellowship-trained radiologist using the DeLong test. Results The training set included 381 patients (mean age, 69.9 years ± 11.4 [SD]; 193 male) with 1307 vertebrae (378 benign fractures, 447 malignant fractures, 482 malignant lesions). Internal and external test sets included 86 (mean age, 66.9 years ± 12; 45 male) and 65 (mean age, 68.8 years ± 12.5; 39 female) patients, respectively. The better-performing model of two training approaches achieved AUCs of 0.85 (95% CI: 0.77, 0.92) in the internal and 0.75 (95% CI: 0.64, 0.85) in the external test sets. Including an uncertainty category further improved performance to AUCs of 0.91 (95% CI: 0.83, 0.97) in the internal test set and 0.76 (95% CI: 0.64, 0.88) in the external test set. The AUC values of residents were lower than that of the best-performing model in the internal test set (AUC, 0.69 [95% CI: 0.59, 0.78] and 0.71 [95% CI: 0.61, 0.80]) and external test set (AUC, 0.70 [95% CI: 0.58, 0.80] and 0.71 [95% CI: 0.60, 0.82]), with significant differences only for the internal test set (P < .001). The AUCs of the fellowship-trained radiologist were similar to those of the best-performing model (internal test set, 0.86 [95% CI: 0.78, 0.93; P = .39]; external test set, 0.71 [95% CI: 0.60, 0.82; P = .46]). Conclusion Developed models showed a high discriminatory power to differentiate between benign and malignant vertebral fractures, surpassing or matching the performance of radiology residents and matching that of a fellowship-trained radiologist. © RSNA, 2024 See also the editorial by Booz and D'Angelo in this issue.
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Affiliation(s)
- Sarah C Foreman
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - David Schinz
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - Malek El Husseini
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - Sophia S Goller
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - Jürgen Weißinger
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - Anna-Sophia Dietrich
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - Martin Renz
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - Marie-Christin Metz
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - Georg C Feuerriegel
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - Benedikt Wiestler
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - Robert Stahl
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - Benedikt J Schwaiger
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - Marcus R Makowski
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - Jan S Kirschke
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
| | - Alexandra S Gersing
- From the Departments of Radiology (S.C.F., A.S.D., G.C.F., M.R.M.) and Neuroradiology (D.S., M.E.H., M.R., M.C.M., B.W., B.J.S., J.S.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany; Departments of Radiology (S.S.G., J.W.) and Neuroradiology (R.S., A.S.G.), University Hospital Munich (LMU), Munich, Germany; and German Cancer Consortium (DKTK), Partner Site Munich, and German Cancer Research Center (DKFZ), Heidelberg, Germany (B.W.)
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de Holanda NCP, Silva TIAR, Cavalcante AG, Lacerda MB, de Oliveira Viena G, de Carvalho CC, Menezes KT, de Medeiros IRN, Sales MM, E Silva de Queiroz FR, de Arruda Castelo Branco Brito CG, Bandeira F. Prevalence of Morphometric Vertebral Fractures After Bariatric Surgery and Its Relationship with Bone Mineral Density and Bone Markers. Obes Surg 2024; 34:733-740. [PMID: 38285298 DOI: 10.1007/s11695-023-07049-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Bariatric surgery (BS) can lead to bone loss and an increased fracture risk. METHODS To determine the morphometric vertebral fracture (MVF) prevalence, and its relationship with bone mineral density (BMD), and biomarker's turnover after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), we analyzed post-surgery X-rays of the spine in 80 patients (88% female, 51% RYGB, age 41.2 [6.8] years) from 117 participants' retrospective cohort (1-2 years, >2 and <5 years, and >5 years). We still analyzed body composition and BMD by dual-energy X-ray absorptiometry and bone parameters. RESULTS MVF prevalence was 17.5% (14/80), with no statistical difference between groups (p = 0.210). RYGB group had a higher prevalence of secondary hyperparathyroidism (SHPT) (PTH ≥ 65 pg/ml; 18.4% vs 7.8%, respectively, p = 0.04), PTH (61.3 vs 49.5 pg/ml, p = 0.001), CTX (0.766 [0.29] ng/ml vs 0.453 [0.30] ng/ml, p = 0.037), and AP (101.3 [62.4] U/L vs 123.9 [60.9] U/L, p = 0.027) than the SG group. Up to 5 years postoperatively, RYGB had a lower total (1.200 [0.087] vs 1.236 [0.100] g/cm2, p = 0.02), femoral neck (1.034 [0.110] vs 1.267 [0.105], p = 0.005), and total femur BMD (1.256 [0.155] vs 1.323 [0.167], p = 0.002) than SG group. We found no statistically significant difference between the MFV (+) and MVF (-) groups regarding age, sex, BMI, surgery time, BMD, or bone and metabolic parameters, including leptin. CONCLUSION We found a high prevalence of MVF after BS with no differences between RYGB and SG.
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Affiliation(s)
- Narriane Chaves Pereira de Holanda
- Department of Endocrinology, Federal University of Paraiba, Joao Pessoa, Brazil.
- Post-Graduation Program in Health Science, University of Pernambuco Medical School, Recife, Brazil.
| | | | | | | | | | | | | | | | | | | | | | - Francisco Bandeira
- Post-Graduation Program in Health Science, University of Pernambuco Medical School, Recife, Brazil
- Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
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Wang YN, Liu G, Wang L, Chen C, Wang Z, Zhu S, Wan WT, Weng YZ, Lu WW, Li ZY, Wang Z, Ma XL, Yang Q. A Deep-Learning Model for Diagnosing Fresh Vertebral Fractures on Magnetic Resonance Images. World Neurosurg 2024; 183:e818-e824. [PMID: 38218442 DOI: 10.1016/j.wneu.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The accurate diagnosis of fresh vertebral fractures (VFs) was critical to optimizing treatment outcomes. Existing studies, however, demonstrated insufficient accuracy, sensitivity, and specificity in detecting fresh fractures using magnetic resonance imaging (MRI), and fall short in localizing the fracture sites. METHODS This prospective study comprised 716 patients with fresh VFs. We obtained 849 Short TI Inversion Recovery (STIR) image slices for training and validation of the AI model. The AI models employed were yolov7 and resnet50, to detect fresh VFs. RESULTS The AI model demonstrated a diagnostic accuracy of 97.6% for fresh VFs, with a sensitivity of 98% and a specificity of 97%. The performance of the model displayed a high degree of consistency when compared to the evaluations by spine surgeons. In the external testing dataset, the model exhibited a classification accuracy of 92.4%, a sensitivity of 93%, and a specificity of 92%. CONCLUSIONS Our findings highlighted the potential of AI in diagnosing fresh VFs, offering an accurate and efficient way to aid physicians with diagnosis and treatment decisions.
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Affiliation(s)
- Yan-Ni Wang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Gang Liu
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Lei Wang
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, School of Health Sciences & Biomedical Engineering, Hebei University of Technology, Tianjin, China
| | - Chao Chen
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Zhi Wang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Shan Zhu
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Wen-Tao Wan
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Yuan-Zhi Weng
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China; Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen, China
| | - Weijia William Lu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China; Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen, China
| | - Zhao-Yang Li
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin, China
| | - Zheng Wang
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xin-Long Ma
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China.
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Ebstein E, Brocard P, Soussi G, Khoury R, Forien M, Khalil A, Vauchier C, Juge PA, Léger B, Ottaviani S, Dieudé P, Zalcman G, Gounant V. Burden of comorbidities: Osteoporotic vertebral fracture during non-small cell lung cancer - the BONE study. Eur J Cancer 2024; 200:113604. [PMID: 38340385 DOI: 10.1016/j.ejca.2024.113604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/29/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Immunotherapy and targeted therapy have extended life expectancy in non-small cell lung cancer (NSCLC) patients, shifting it into a chronic condition with comorbidities, including osteoporosis. This study aims to evaluate the prevalence and incidence of osteoporotic vertebral fracture (OPVF) during NSCLC follow-up, identify risk factors of OPVF, and determine the impact on overall survival (OS). METHODS We performed a longitudinal single-center retrospective cohort study involving patients with histologically proven NSCLC of any stage. Chest-abdomen-pelvis computed tomography (CAP CT) at diagnosis and during follow-up were double-blind reviewed to determine OPVF site, count, type, time to incident OPVF, and trabecular volumetric bone density (TVBD). An institutional expert committee adjudicated discrepancies. Binary logistic regression was used to predict the occurrence of incident OPVF. OS was calculated using the Kaplan-Meier method. RESULTS We included 289 patients with a median follow-up of 29.7 months. OPVF prevalence was 10.7% at inclusion and 23.2% at the end of follow-up. Cumulative incidence was 12.5%, with an incidence rate of 4 per 100 patient-years. Median time to incident OPVF was 13 months (IQR: 6.7-21.2). Seven of the 36 patients with incident OPVF received denosumab or bisphosphonates. In multivariable analysis, independent risk factors for incident OPVF were BMI < 19 kg/m2 (OR: 5.62, 95%CI 1.84-17.20, p = 0.002), lower TVBD (OR: 0.982 per HU, 95%CI 0.97-0.99, p = 0.001) and corticosteroid use (OR: 4.77, 95%CI: 1.76-12.89, p = 0.001). OPVF was not significantly associated with OS. CONCLUSIONS Osteoporosis should be screened for in NSCLC patients. Thoracic oncologists must broaden the use of steroid-induced osteoporosis recommendations.
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Affiliation(s)
- E Ebstein
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - P Brocard
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - G Soussi
- Pulmonology Department, Hôpital Forcilles - Fondation Cognacq-Jay, 77150 Férolles-Attily, France
| | - R Khoury
- Université Paris Cité, Radiology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - M Forien
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - A Khalil
- Université Paris Cité, Radiology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - C Vauchier
- Université Paris Cité, Thoracic Oncology Department, CIC INSERM 1425, Institut du Cancer AP-HP.Nord, Hôpital Bichat Claude-Bernard, Paris, France
| | - P A Juge
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - B Léger
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - S Ottaviani
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - P Dieudé
- Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France
| | - G Zalcman
- Université Paris Cité, Thoracic Oncology Department, CIC INSERM 1425, Institut du Cancer AP-HP.Nord, Hôpital Bichat Claude-Bernard, Paris, France
| | - V Gounant
- Université Paris Cité, Thoracic Oncology Department, CIC INSERM 1425, Institut du Cancer AP-HP.Nord, Hôpital Bichat Claude-Bernard, Paris, France.
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Booz C, D'Angelo T. Improved Vertebral Fracture Assessment: The Game-Changing Potential of Deep Learning with Multidetector CT. Radiology 2024; 310:e240409. [PMID: 38530170 DOI: 10.1148/radiol.240409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Christian Booz
- From the Department of Diagnostic and Interventional Radiology, Division of Experimental Imaging, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany (C.B., T.D.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (C.B.); Department of Dental and Morphological and Functional Imaging, Diagnostic and Interventional Radiology Unit, University Hospital Messina, Messina, Italy (T.D.); and Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands (T.D.)
| | - Tommaso D'Angelo
- From the Department of Diagnostic and Interventional Radiology, Division of Experimental Imaging, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany (C.B., T.D.); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany (C.B.); Department of Dental and Morphological and Functional Imaging, Diagnostic and Interventional Radiology Unit, University Hospital Messina, Messina, Italy (T.D.); and Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands (T.D.)
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Mansi Z, Rbai H, Saibi F, Saadana J, Chermiti W, Zaidi B. Our experience with the surgical management of lower cervical spine fractures: fifty case series. Int Orthop 2024; 48:817-830. [PMID: 38182851 DOI: 10.1007/s00264-023-06076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/16/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE Trauma to the lower cervical spine is a serious lesion due to its neurological consequences which jeopardize the vital and functional prognosis. They constitute a public health problem due to their frequency and seriousness requiring rapid and adequate treatment. The aim of our study is to (1) describe the epidemiological, clinical, and radiological characteristics of lower cervical spine trauma patients; (2) support the therapeutic management of these patients and show our experience in surgery for lower cervical spine trauma; and (3) analyze the anatomical and functional results and discuss them with literature data. METHODS This is a retrospective descriptive study of 50 patients with lower cervical spine trauma treated surgically over a period of five years from January 1, 2016, to December 2020. RESULTS The average age of our patients was 34.5 years, with a sex ratio of 1.7. The etiologies are dominated by accidents on public roads (58%). They show neurological disorders such as spinal cord damage in 30% of cases and root damage in 20% of cases. The radiological assessment revealed eight tear drops, ten comminuted fractures, 12 severe sprains, 12 biarticular dislocations, six uniarticular dislocations, and two herniated discs. Treatment was surgical in all patients with an anterolateral approach and anterior arthrodesis. The evolution was favourable in 21 patients and stationary in 29 patients. CONCLUSION Our study concluded that dislocations and fracture dislocations were the predominant type of injury in cases of AVP. Tetraplegia was mainly observed with uni- and biarticular dislocations. The variation in consolidation time was not correlated with trauma-to-surgery time. Better neurological recovery was observed with mild initial neurological damage than with initially severe damage. The appearance of an adjacent syndrome is less frequent with monosegmental arthrodesis than with multisegmental arthrodesis. Cage arthrodesis was an alternative to iliac harvesting with similar results.
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Affiliation(s)
- Zied Mansi
- University of Sousse, Sousse, Tunisia.
- Tunisian Society of Orthopaedic and Traumatolgy Surgery, Tunis, Tunisia.
| | - Hedi Rbai
- University of Sousse, Sousse, Tunisia
- Tunisian Society of Orthopaedic and Traumatolgy Surgery, Tunis, Tunisia
| | - Firas Saibi
- University of Sousse, Sousse, Tunisia
- Tunisian Society of Orthopaedic and Traumatolgy Surgery, Tunis, Tunisia
| | - Jacem Saadana
- Tunisian Society of Orthopaedic and Traumatolgy Surgery, Tunis, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Wajdi Chermiti
- University of Sousse, Sousse, Tunisia
- Tunisian Society of Orthopaedic and Traumatolgy Surgery, Tunis, Tunisia
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Lee SH, Lee S, Jang SW, Shin HK, Kim DH, Kang DH, Jeon SR, Roh SW, Park JH. Unilateral Pediculectomy and Reduction with Short-Segment Pedicle Screw Fixation for Thoracolumbar Burst Fracture: A Case Series. World Neurosurg 2024; 183:e116-e126. [PMID: 38042288 DOI: 10.1016/j.wneu.2023.11.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the efficacy of unilateral pediculectomy and reduction with short-segment pedicle screw fixation for thoracolumbar burst fracture. METHODS We retrospectively reviewed patients who underwent a unilateral pediculectomy and reduction with short-segment fixation and interbody fusion for thoracolumbar burst fracture. The unilateral pediculectomy created sufficient space to approach the ventral side of the spinal cord for removing bone fragments and insertion of an interbody cage to correct kyphosis. Lumbar lordosis (LL), pelvic incidence (PI) minus LL, and segmental Cobb angle were measured at 3 time points: preoperatively, postoperatively, and final follow-up. Furthermore, sagittal vertical axis (SVA) was measured to assess global sagittal balance at the final follow-up. RESULTS A total of 10 patients, with a mean age of 39.8 ± 21.0, underwent the surgical procedure. All patients had a thoracolumbar injury classification and severity score > 5. The mean follow-up period was 15.8 ± 13.9 months. The mean postoperative LL (46.0 ± 5.8) was significantly higher (P = 0.008) than the preoperative measurement (32.8 ± 8.2). The mean postoperative PI minus LL (2.2 ± 8.4) was not significantly lower (P = 0.051) than preoperative measurement (15.4 ± 12.6). The mean postoperative segmental Cobb angle (11.4 ± 8.4) was significantly higher (P < 0.001) than the preoperative measurement (-11.6 ± 10.9). At the final follow-up, the mean sagittal vertical axiswas 10.0 ± 28.8 mm. CONCLUSIONS Unilateral pediculectomy and reduction with short-segment fixation and interbody fusion served as an efficient surgical method for thoracolumbar burst fracture.
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Affiliation(s)
- Sang Hyub Lee
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju-Si, Gyeongsangnam-do, Republic of Korea
| | - Subum Lee
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sun Woo Jang
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Kyung Shin
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Hwan Kim
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju-Si, Gyeongsangnam-do, Republic of Korea
| | - Dong Ho Kang
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju-Si, Gyeongsangnam-do, Republic of Korea
| | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Woo Roh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Ngan S, Rampersadh C, Rycman A, Cronin DS. Smoothed particle hydrodynamics implementation to enhance vertebral fracture finite element model in a cervical spine segment under compression. J Mech Behav Biomed Mater 2024; 151:106412. [PMID: 38262183 DOI: 10.1016/j.jmbbm.2024.106412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 01/25/2024]
Abstract
Spinal cord injuries (SCIs) can arise from compression loading when a vertebra fractures and bone fragments are pushed into the spinal canal. Experimental studies have demonstrated the importance of both fracture initiation and post-fracture response in the investigation of vertebral fractures and spinal canal occlusion resulting from compression. Finite element models, such as the Global Human Body Models Consortium (GHBMC) model, focused on predicting the initiation location of fractures using element erosion to model hard tissue fracture. However, the element erosion method resulted in a loss of material and structural support during compression, which limited the ability of the model to predict the post-fracture response. The current study aimed to improve the post-fracture response by combining strain-based element erosion with smoothed particle hydrodynamics (SPH) to preserve the volume of the trabecular bone during compression fracture. The proposed implementation was evaluated using a model comprising two functional spinal units (FSUs) (C5-C6-C7) extracted from the GHBMC 50th percentile male model, and loaded under central compression. The original and enhanced models were compared to experimental force-displacement data and measured occlusion of the spinal canal. The enhanced model with SPH improved the shape and magnitude of the force-displacement response to be in good agreement with the experimental data. In contrast to the original model, the enhanced SPH model demonstrated occlusion on the same order of magnitude as reported in the experiments. The SPH implementation improved the post-fracture response by representing the damaged material post-fracture, providing structural support throughout compression loading and material flow leading to occlusion.
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Affiliation(s)
- S Ngan
- Mechanical & Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Canada
| | - C Rampersadh
- Mechanical & Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Canada
| | - A Rycman
- Mechanical & Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Canada
| | - D S Cronin
- Mechanical & Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Canada.
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Sevillano-Perez E, Prado-Novoa M, Postigo-Pozo S, Peña-Trabalon A, Guerado E. L4 fixation is not necessary in L5-Iliac spinopelvic fixation after trauma, but coadjutant transilio-transsacral fixation is. Injury 2024; 55:111378. [PMID: 38309085 DOI: 10.1016/j.injury.2024.111378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/28/2023] [Accepted: 01/20/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Spinopelvic dissociation (SPD) is a severe injury characterized by a discontinuity between the spine and the bony pelvis consisting of a bilateral longitudinal sacral fracture, most of the times through sacral neuroforamen, and a horizontal fracture, usually through the S1 or S2 body. The introduction of the concept of triangular osteosynthesis has shown to be an advance in the stability of spinopelvic fixation (SPF). However, a controversy exists as to whether the spinal fixation should reach up to L4 and, if so, it should be combined with transiliac-transsacral screws (TTS). OBJECTIVE The purpose of this study is to compare the biomechanical behavior in the laboratory of four different osteosynthesis constructs for SPD, including spinopelvic fixation of L5 versus L4 and L5; along with or without TTS in both cases. MATERIAL AND METHODS By means of a formerly described method by the authors, an unstable standardized H-type sacral fracture in twenty synthetic replicas of a male pelvis articulated to the lumbar spine, L1 to sacrum, (Model: 1300, SawbonesTM; Pacific Research Laboratories, Vashon, WA, USA), instrumented with four different techniques, were mechanically tested. We made 4 different constructs in 5 specimen samples for each construct. Groups: Group 1. Instrumentation of the L5-Iliac bones with TTS. Group 2. Instrumentation of the L4-L5-Iliac bones with TTS. Group 3. Instrumentation of L5-Iliac bones without TTS. Group 4: Instrumentation of L4-L5-Iliac bones without TTS. RESULTS AND CONCLUSIONS According to our results, it can be concluded that in SPD, better stability is obtained when proximal fixation is only up to L5, without including L4 (alternative hypothesis), the addition of transiliac-transsacral fixations is essential.
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Affiliation(s)
| | - Maria Prado-Novoa
- Clinical Biomechanics Laboratory of Andalusia (BIOCLINA), University of Malaga, Malaga, Spain
| | - Sergio Postigo-Pozo
- Clinical Biomechanics Laboratory of Andalusia (BIOCLINA), University of Malaga, Malaga, Spain
| | - Alejandro Peña-Trabalon
- Clinical Biomechanics Laboratory of Andalusia (BIOCLINA), University of Malaga, Malaga, Spain
| | - Enrique Guerado
- School of Medicine, University of Malaga, Malaga, Spain; Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, Marbella Malaga, Spain.
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Li HL, Shen Y, Tan LH, Fu SB, Guan CH, Zhen DH, Lv HH, Wu XY, Tang XL. Association between BMI and osteoporotic fractures at different sites in Chinese women: a case-control retrospective study in Changsha. BMC Musculoskelet Disord 2024; 25:187. [PMID: 38424521 PMCID: PMC10903060 DOI: 10.1186/s12891-024-07271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Osteoporotic fractures are a growing problem in an aging society. The association between body mass index (BMI) and osteoporotic fractures varies by fracture site and ethnicity. Limited knowledge exists regarding this association in native Chinese, particularly utilizing local databases as reference sources. OBJECTIVE To investigate the association between BMI and osteoporotic fractures at different sites in Chinese women. METHODS Three thousand ninety-eight female patients with radiographic fractures and 3098 age- and sex-matched healthy controls without fractures were included in the study. Both of them underwent assessment using dual-energy X-ray absorptiometry (DXA), with BMD measurements calculated using our own BMD reference database. Participants were classified into underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 24.0 kg/m2), overweight (24 ≤ BMI < 28 kg/m2) and obese (BMI ≥ 28 kg/m2) according to the Chinese BMI classification standard. RESULTS There were 2296 (74.1%) vertebral fractures, 374 (12.1%) femoral neck fractures, and 428 (13.8%) other types of fractures in the case group. Bone mineral density (BMD) was almost lower in the fracture groups compared to the control groups (p = 0.048 to < 0.001). Compared with normal weight, underweight had a protective effect on total [odds ratio (OR) = 0.61; 95% confidence interval (CI), 0.49 -0.75; P< 0.001], and lumbar fractures (OR = 0.52; 95% CI, 0.41 - 0.67; P < 0.001), while obesity was associated with an increased risk for total (OR = 2.26; 95% CI, 1.85 - 2.76; P < 0.001), lumbar (OR = 2.17; 95% CI, 1.72 - 2.73; P < 0.001), and femoral neck fractures (OR = 4.08; 95% CI, 2.18 - 7.63; P < 0.001). Non-linear associations were observed between BMI and fractures: A J-curve for total, lumbar, and femoral neck fractures, and no statistical change for other types of fractures. Underweight was found to be a risk factor for other types of fracturess after adjusting for BMD (OR = 2.29; 95% CI, 1.09 - 4.80; P < 0.001). Osteoporosis and osteopenia were identified as risk factors for almost all sites of fracture when compared to normal bone mass. CONCLUSIONS Underweight has a protective effect on total and lumbar spine fractures in Chinese women, while obesity poses a risk factor for total, lumbar, and femoral neck fractures. The effect of BMI on fractures may be mainly mediated by BMD.
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Affiliation(s)
- Hong-Li Li
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
- Department of Metabolism and Endocrinology, and Hunan Provincial Key Laboratory for Metabolic Bone Diseases, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, PR China
| | - Yi Shen
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, PR China
| | - Li-Hua Tan
- Department of Radiology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, PR China
| | - Song-Bo Fu
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
| | - Cong-Hui Guan
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
| | - Dong-Hu Zhen
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
| | - Hai-Hong Lv
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
| | - Xi-Yu Wu
- Department of Metabolism and Endocrinology, and Hunan Provincial Key Laboratory for Metabolic Bone Diseases, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, PR China.
| | - Xu-Lei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China.
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Norisyam Y, Zairul Anuar KB, Ohn KM, Moharzudi M. Rare vertebral pathological fracture in primary amyloidosis. BMJ Case Rep 2024; 17:e258973. [PMID: 38388204 PMCID: PMC10884212 DOI: 10.1136/bcr-2023-258973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Spinal involvement in primary amyloidosis is an exceedingly rare condition, presenting with typical pathological fracture symptoms that are often indistinguishable from other pathologies such as bone metastasis, metabolic disorders and infections. Histopathological studies for tissue diagnosis are the cornerstone of a definitive diagnosis, leading to successful treatment. Early diagnosis and intervention play a pivotal role in the care of patients with amyloidosis. Here, we present a unique case of a pathological fracture in the L4 vertebra following minor trauma. This fracture manifested with pain, instability and limitations in daily activities in a patient who had already been diagnosed with systemic amyloidosis and was undergoing chemotherapy. This case represents a distinct instance of vertebral involvement in amyloidosis and was managed with both chemotherapy and surgical intervention to address the spinal pathology, resulting in favourable outcomes.
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Affiliation(s)
- Yusoff Norisyam
- Department of Orthopaedic, Hospital Sultan Ismail, Johor Bharu, Johor Darul Ta'zim, Malaysia
| | | | - Khin Maung Ohn
- Orthopaedic Surgery, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Mohamed Moharzudi
- Department of Pathology, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
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Shankar D, Kaif M, Kumar K. Post-traumatic lumbar nerve root entrapment into the spinous process of the lumbar spine. BMJ Case Rep 2024; 17:e257802. [PMID: 38373811 PMCID: PMC10882333 DOI: 10.1136/bcr-2023-257802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
Thoracolumbar fractures constitute a significant portion of spinal trauma, accounting for 15-20% of the cases. These fractures, caused by high-impact injuries, may involve tears of the posterior ligamentous complex, presenting a high chance of neurological injury ranging from dural tears to spinal root avulsion. This case report discusses a rare occurrence of avulsion of lumbosacral nerve roots posteriorly, becoming entrapped in the fractured spinous process of the L2 lumbar vertebra, leading to cauda equina syndrome following trauma and its implications during surgery.
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Affiliation(s)
- Diwakar Shankar
- Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mohammad Kaif
- Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Krishna Kumar
- Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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50
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Jia R, Sun Y, Liu C, Liu RC, Long Y. 'Skip' osteoporosis vertebral compression fractures caused by electrical injury: a case report and review of the literature. J Med Case Rep 2024; 18:55. [PMID: 38351016 PMCID: PMC10865546 DOI: 10.1186/s13256-024-04358-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Electrical injuries rarely result in fractures, such as long bone fractures and spinal fractures. A few articles have reported osteoporosis vertebral compression fractures (OVCFs) caused by electrical injuries. Here, we present a rare case of 37-year-old male suffering from the 9th thoracic (T9) and 5th lumbar (L5) OVCFs after receiving a electric shock. CASE PRESENTATION A 37-year-old Han male experienced an electric shock (480 V direct current) at the working time and felt immediately serious back pain. He did not fall and lose consciousness. X-ray and magnetic resonance imaging showed acute OVCFs, as well as dual-energy X-ray absorptiometry indicated osteoporosis. Normal laboratory tests can avoid secondary osteoporosis resulting from metabolic diseases and tumors. Finally, he was diagnosed with acute discontinuous OVCFs (T9 and L5). The patient denied having a history of back pain, whereas, he had a history of smoking, alcohol abuse, and congenital heart disease (tetralogy of Fallot) were associated with osteoporosis. Considering no local kyphosis and < 50% anterior body compression, we selected conservative treatment for this patient. At a 1-year and 3-year follow-up, the lateral thoracic and lumbar radiography demonstrated no instability of the spine, and the back pain has been relieved. CONCLUSIONS This rare case reminds us the importance of consulting a detailed medical history when we encounter young patients receiving electrical injuries. Discontinuously OVCFs must not be overlooked, even though we encounter a young man.
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Affiliation(s)
- Ruili Jia
- The Department of Nephropathy, Baoding First Central Hospital, Baoding, Hebei, People's Republic of China
| | - Yanhao Sun
- The Third Department of Orthopedics, Baoding First Central Hospital, Baoding, Hebei, 071000, People's Republic of China
| | - Chong Liu
- The Department of Radiology, Baoding First Central Hospital, Baoding, Hebei, People's Republic of China
| | - Rui-Chao Liu
- The Department of Radiology, Baoding First Central Hospital, Baoding, Hebei, People's Republic of China
| | - Yubin Long
- The Third Department of Orthopedics, Baoding First Central Hospital, Baoding, Hebei, 071000, People's Republic of China.
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