Clinical Spine Research Articles

Deep Learning for Multi-Tissue Segmentation and Fully Automatic Personalized Biomechanical Models from BACPAC Clinical Lumbar Spine MRI.

In vivo retrospective study of fully automatic quantitative imaging feature extraction from clinically acquired lumbar spine magnetic resonance imaging (MRI). To demonstrate the feasibility of substituting automatic for human-demarcated segmentation of major anatomic structures in clinical lumbar spine MRI to generate quantitative image-based features and biomechanical models. Previous studies have demonstrated the viability of automatic segmentation applied to medical images; however, the feasibility of these networks to segment clinically acquired images has not yet been demonstrated, as they largely rely on specialized sequences or strict quality of imaging data to achieve good performance. Convolutional neural networks were trained to demarcate vertebral bodies, intervertebral disc, and paraspinous muscles from sagittal and axial T1-weighted MRIs. Intervertebral disc height, muscle cross-sectional area, and subject-specific musculoskeletal models of tissue loading in the lumbar spine were then computed from these segmentations and compared against those computed from human-demarcated masks. Segmentation masks, as well as the morphological metrics and biomechanical models computed from those masks, were highly similar between human- and computer-generated methods. Segmentations were similar, with Dice similarity coefficients of 0.77 or greater across networks, and morphological metrics and biomechanical models were similar, with Pearson R correlation coefficients of 0.69 or greater when significant. This study demonstrates the feasibility of substituting computer-generated for human-generated segmentations of major anatomic structures in lumbar spine MRI to compute quantitative image-based morphological metrics and subject-specific musculoskeletal models of tissue loading quickly, efficiently, and at scale without interrupting routine clinical care.

PixelPrint: Three-dimensional printing of patient-specific soft tissue and bone phantoms for CT.

Patient-based CT phantoms, with realistic image texture and densities, are essential tools for assessing and verifying CT performance in clinical practice. This study extends our previously presented 3D printing solution (PixelPrint) to patient-based phantoms with soft tissue and bone structures. To expand the Hounsfield Unit (HUs) range, we utilize a stone-based filament. Applying PixelPrint, we converted patient DICOM images directly into FDM printer instructions (G-code). Density was modeled as the ratio of filament to voxel volume to emulate attenuation profiles for each voxel, with the filament ratio controlled through continuous modification of the printing speed. Two different phantoms were designed to demonstrate the high reproducibility of our approach with micro-CT acquisitions, and to determine the mapping between filament line widths and HU values on a clinical CT system. Moreover, a third phantom based on a clinical cervical spine scan was manufactured and scanned with a clinical spectral CT scanner. CT image of the patient-based phantom closely resembles the original CT image both in texture and contrast levels. Measured differences between patient and phantom are around 10 HU for bone marrow voxels and around 150 HU for cortical bone. In addition, stone-based filament can accurately represent boney tissue structures across the different x-ray energies, as measured by spectral CT. This study demonstrates the feasibility of our 3D-printed patient-based phantoms to be extended to soft-tissue and bone structure while maintaining accurate organ geometry, image texture, and attenuation profiles for spectral CT.

Factors which affect the application and implementation of a spinal motion restriction protocol by prehospital providers in a low resource setting: A scoping review.

The safety and effectiveness of prehospital clinical c-spine clearance or spinal motion restriction (SMR) decision support tools are unclear. The present study aimed to examine the available literature on clinical cervical spine clearance and selective SMR decision support tools to identify possible barriers to implementation, safety, and effectiveness when used by emergency medical service (EMS) practitioners. We performed a focused scoping review of published literature on the prehospital use of clinical c-spine clearance and SMR decision tools in adult blunt trauma patients. The Medline, Embase, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature, Web of Science, Turning Research into Practice and EBSCOhost online databases were searched (February 2021). The type of decision support tool and facilitators and barriers to its use were extracted from each included publication in accordance with a modified descriptive-analytical framework. Extracted data were subjected to thematic analysis. Following screening, forty-two articles were included in this scoping review. No studies conducted specifically in low resource settings were found. The majority of articles (57%) evaluated the use of specific SMR decision support tools, such as the National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian C-spine Rule (CCR). Potential facilitators of safe and effective use were identified in 60%, and potential barriers to safe and effective use in 55% of included articles. Only one study evaluated the CCR when used by EMS practitioners, making it difficult to determine its appropriateness for implementation in the prehospital setting. This is the first scoping review, to our knowledge, that has attempted to identify the possible barriers and facilitators to their implementation, safety, and effectiveness when used by EMS practitioners. Key issues identified included terminology, guideline compliance and implementation, and a lack of context-specific evidence. These may provide important considerations for future guideline development.

232. Inhibition of neurogenic inflammatory pathways associated with reduction in discogenic back pain

<h3>BACKGROUND CONTEXT</h3> Calcitonin gene-related peptide (CGRP), a neuropeptide found in abundance at the interface between blood vessels and sensory nerve fibers, upregulates pro-inflammatory cytokines including tumor necrosis factor-α, interleukin-6, brain derived neurotrophic factor, and nerve growth factor in spinal spondylotic disease resulting in disc degeneration and sensitization of nociceptive neurons. While the new class of anti-CGRP medications have proven ability to quell neurogenic inflammation in migraines, their off-site efficacy as a therapeutic target for discogenic back/neck pain conditions remains unknown. <h3>PURPOSE</h3> Utilizing a patient population with comorbid degenerative spinal disease and migraines, this study aims to determine if initiation of anti-CGRP biologic treatment for migraines was also associated with improvements in back/neck pain, mobility, and function. <h3>STUDY DESIGN/SETTING</h3> Retrospective case series. <h3>PATIENT SAMPLE</h3> All patients over age 18 with concomitant spinal spondylosis and migraine diagnoses treated with anti-CGRP medications at a single academic institution between 2017-2020 were retrospectively identified. Patients with history of spinal surgery, malignancy, cervicogenic headache, new narcotic prescriptions or inconsistent anti-CGRP use were excluded. <h3>OUTCOME MEASURES</h3> Clinical spine outcomes before and after anti-CGRP medication initiation including pain, mobility and functional status. <h3>METHODS</h3> Patient demographic (age, sex, race, smoking status, BMI) and medical (CCI, depression, anxiety, fibromyalgia) data, follow-up duration, migraine severity and frequency, spine pain, functional status, and mobility before and after anti-CGRP medication initiation were collected. Paired univariate analysis tested for significant changes in spine pain, headache severity, and headache frequency before and after beginning anti-CGRP. Correlation between changes in spine pain score and functional or mobility improvement were assessed with the Spearman's rho coefficient. <h3>RESULTS</h3> A total of 56 patients were included. The mean follow-up time after anti-CGRP initiation was 123 days for spine visits and 129 days for migraine visits. Back/neck pain decreased significantly (p<0.001) from 6.30 to 4.36 after starting anti-CGRP medication for migraine control. As recorded in the spine follow-up notes, 25% of patients experienced functional improvement in ADLs and 17.5% of patients experienced mobility improvement while taking anti-CGRP medication. Change in back/neck pain demonstrated a moderate correlation (ρ= -0.430) with functional improvement but no correlation with mobility improvement (ρ= -0.052). <h3>CONCLUSIONS</h3> Patients receiving anti-CGRP treatment for chronic migraines with comorbid degenerative spine conditions experienced significant off-target back/neck pain reduction. Future interventional studies are necessary to explore the effectiveness of this novel medication class in all patients with discogenic back/neck pain that is recalcitrant to standard nonoperative therapies. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Accuracy of ct evaluation for cervical spine clearance in the ground level fall population – a retrospective cohort study

BackgroundClinically occult cervical spine (CS) injuries are well described in blunt trauma, however delay in identifying these injuries and clearing the CS can result in morbidity. Our study examines the ground level fall (GLF) population to analyze whether computed tomography (CT) alone can rule out unstable injury in this group with lower force mechanism.MethodsThis is a single center, retrospective cohort study. All GLF patients in the institutional trauma registry between 6/1/2012 through 12/31/2019 were included. These comprise all trauma patients evaluated in the emergency department with Injury Severity Score (ISS) > 0, including both activations and consults with both clinical and radiological spine evaluation. Patients who could not be cleared by National Emergency X-ray Utilization Study (NEXUS) criteria underwent CT. Patients with CT or clinical suspicion of cord or ligamentous injury underwent MRI. CT occult injuries were identified by MRI and clinical exam, with MRI identifying all unstable injuries.ResultsSixty-nine (2.0%) of patients had CS injury without acute CT abnormality. Of these, 11 (0.3%) required surgery and were considered unstable. All patients who required surgery had a neurologic deficit. Negative predictive value (NPV) of CT for unstable CS injury was 99.7%. The combination of acute CT findings and neurologic deficit ruled out unstable CS injury with 100% NPV.ConclusionIn the GLF population, CT alone rules out unstable CS injury with high, but not perfect NPV. The combination of absence of acute CT findings and acute neurologic deficits rules out unstable CS injury with 100% NPV.

Assessment of bone densitometry using radiography with a step-wedge phantom: a pilot study of the forearm.

Radiographic absorptiometry (RA) is one of the earliest methods of bone densitometry and has been used to measure the phalanges and metacarpals where soft tissue attenuation is minimal. The aim of this study was to determine whether the technique can be adapted to correct for soft tissue attenuation and measure areal bone mineral density (aBMD) in the forearm. A total of 51 patients referred for a clinical spine and hip dual-energy X-ray absorptiometry (DXA) examination and 8 young and middle-aged volunteers were recruited to this study. The first 29 participants (20 women, 9 men, aged 61±14 years) served as the training cohort, and the remaining 30 (20 women, 10 men, aged 55±16 years) comprised the validation cohort. All participants underwent a DXA scan of their non-dominant forearm, and a digital X-ray image of the same arm was acquired with a step phantom. Identical regions of interest (ROIs) in the radius and ulna at the one-third radius site were measured on the X-ray and DXA images, and a soft tissue ROI was measured on X-ray images between the radius and ulna. The X-ray measurements in the training cohort were expressed as equivalent step phantom thickness (Eq. SPT) and used to estimate forearm aBMD using a linear equation calibrated against the DXA scans. Estimates of forearm aBMD made from the digital X-ray images acquired in the validation cohort were compared with the results of the DXA scans. Digital X-ray estimates of radius and ulna aBMD at the one-third radius site in the validation cohort showed a good correlation with GE-Lunar iDXA scanner measurements (r=0.795; P<0.001). The Bland-Altman plot had a mean bias of -0.002 g/cm2 and 95% limits of agreement of -0.185 to +0.181 g/cm2. Digital X-ray estimates of proximal forearm aBMD corrected for soft tissue attenuation correlated with DXA measurements with correlation coefficients comparable to those seen for other peripheral bone densitometry technologies.

Clinical evaluation versus magnetic resonance imaging findings in patients with radicular arm pain-A pragmatic study.

ObjectivesCervical nerve root compression can lead to radiculopathy in the arm. Some studies have reported low accuracy in determining the responsible nerve root in both cervical and lumbar regions. This prospective, observational, pragmatic study aimed to determine the accuracy of the clinical evaluation relative to magnetic resonance imaging (MRI) findings in patients with arm radiculopathy.MethodsPatients with neck pain and neck‐related arm pain referred to a spine unit underwent a standard clinical neurological examination and cervical spine MRI. The clinical examination required a judgment of the most likely cervical root involved, including the side. The Interobserver reproducibility was tested. Using MRI, the most likely nerve root involved according to radiology was assessed.ResultsEighty‐three patients met the inclusion criteria. The Interobserver reproducibility between clinical evaluators was 58%, with a modest κ coefficient (0.33, 95% confidence interval [CI]: 0.18–0.47) classified only as "fair agreement.” Only 31% (95% CI: 22–42) of the 83 patients exhibited full agreement regarding the suspected cervical root as assessed via the clinical evaluation and MRI. In another 28% (95% CI: 18–39), the clinical evaluation identified an adjacent level to that identified on MRI.ConclusionsIn cervical radiculopathy, the clinical‐neurological examination diagnosed the same in 31% or an adjacent cervical root in 28% of the patients in relation to the most affected cervical root on MRI.

Quantitative cervical spine injury responses in whiplash loading with a numerical method of natural neural reflex consideration

Background and objectiveNeural reflex is hypothesized as a regulating step in spine stabilizing system. However, neural reflex control is still in its infancy to consider in the previous finite element analysis of head-neck system for various applications. The purpose of this study is to investigate the influences of neural reflex control on neck biomechanical responses, then provide a new way to achieve an accurate biomechanical analysis for head-neck system with a finite element model. MethodsA new FE head-neck model with detailed active muscles and spinal cord modeling was established and globally validated at multi-levels. Then, it was coupled with our previously developed neuromuscular head-neck model to analyze the effects of vestibular and proprioceptive reflexes on biomechanical responses of head-neck system in a typical spinal injury loading condition (whiplash). The obtained effects were further analyzed by comparing a review of epidemiologic data on cervical spine injury situations. ResultThe results showed that the active model (AM) with neural reflex control obviously presented both rational head-neck kinematics and tissue injury risk referring to the previous experimental and epidemiologic studies, when compared with the passive model (PM) without it. Tissue load concentration locations as well as stress/strain levels were both changed due to the muscle activation forces caused by neural reflex control during the whole loading process. For the bony structures, the AM showed a peak stress level accounting for only about 25% of the PM. For the discs, the stress concentrated location was transferred from C2-C6 in the PM to C4-C6 in the AM. For the spinal cord, the strain concentrated locations were transferred from C1 segment to around C4 segment when the effects of neural reflex control were implemented, while the gray matter and white matter peak strains were reduced to 1/3 and 1/2 of the PM, respectively. All these were well correlated with epidemiological studies on clinical cervical spine injuries. ConclusionIn summary, the present work demonstrated necessity of considering neural reflex in FE analysis of a head-neck system as well as our model biofidelity. Overall results also verified the previous hypothesis and further quantitatively indicated that the muscle activation caused by neural reflex is providing a protection for the neck in impact loading by decreasing the strain level and changing the possible injury to lower spinal cord level to reduce injury severity.

Abstract No. : ABS2375: Prevalence of facet joint arthropathy in patients with chronic low back pain having prolapsed intervertebral disc- A prospective analytical study

Background and Aims:Low back pain (LBP) is a major global public health problem with facet joints and intervertebral discs as the common pain generators. This study aimed to determine the prevalence of facet joint arthropathy (FJA) using diagnostic block inpatients with radiologically diagnosed prolapsed intervertebral disc (PIVD).Methods:This prospective study was conducted from January to July, 2018 on 65 adult patients with chronic LBP (magnetic resonance image(MRI) showing PIVD) . Fifty patients ,who were clinically suspected with FJA ,were given fluoroscopy-guided dual diagnostic median branch block (MBB) with 0.5 ml 2% lignocaine and 0.25% bupivacaine in two different sittings. At least 80% of concordant pain relief (assessed by Visual Analogue Scale(VAS)) was considered as a positive diagnostic block. Patients were divided as group P and group N based on positive and negative diagnostic MBB , respectively. Prevalence of positive block among total study population was calculated.Results:All demographic parameters were comparable between both groups. Number of patients in group P and group N were 36 and 14 respectively. There were significant difference in duration of block, post block pain relief (%) and VAS score after lignocaine and bupivacaine among both the groups(figure 1). No significant complications were seen in any group. Calculated prevalence of positive MBB in the 65 patients was 55.38%.Figure 1 – Comparison of pain relief after medial branch block using lignocaine and bupivacaineInterpretationPost block pain relief (%)Post block VAS scoreDuration of pain relief P Lignocaine Mean±SDBupivacaine Mean±SDLignocaine Mean±SDBupivacaine Mean±SDLignocaine Mean±SDBupivacaine Mean±SDN (14)36.78±21.6237.86±14.234.64±1.454.64±0.7476.07±30.83152.14±51.910.00P (36)79.72±6.7583.06±6.032.31±0.4671.81±0.52190.83±21.696425.83±28.52Total67.7±23.1570.40±22.352.96±1.362.6±1.41188.70±57.42349.2±29.25Conclusion:Symptoms and MRI results fair poorly in diagnosing the exact cause of LBP. Prevalence of FJA was quite high in radiologically diagnosed PIVD which indicates that clinical correlation outweigh spine imaging.

'Healthier Chinese spine': an update of osteoporotic fractures in men (MrOS) and in women (MsOS) Hong Kong spine radiograph studies.

For the MrOS (Hong Kong) and MsOS (Hong Kong) baseline (BL) studies, community-dwelling 2,000 Chinese men (mean age: 72.3 years) and 2,000 Chinese women (mean age: 72.5 years) were recruited from 2001 to 2003. These two studies have spanned two decades till now. This review summarizes our spine radiograph results. Senile and post-menopausal osteoporosis were associated with intervertebral disc volume reduction; and in women, menopause accelerates disc degeneration. Elderly women's osteoporotic vertebral fracture (OVF) prevalence was double of that of elderly men. For year-4 follow-up (FU), male participants with BL OVF had little increased risk for further OVF. In our study comparing OVF rates in age-matched Hong Kong Chinese women and Italian Caucasian women (mean age: 74.1 years), endplate and/or cortex fracture (ECF) prevalence was 26% for Chinese and 47% for Italian. OVF with ≥40% vertebral height loss was recorded among 9.5% of the Chinese subjects while among 26% of the Italian subjects. OVFs in Italian subjects were more likely to be multiple and generally severer. Clinical spine fractures were recorded 133 cases/100,000 person-years in MrOS (Hong Kong) participants and 273 cases/100,000 person-years in MsOS (Hong Kong) participants. Literature review suggests the clinical vertebral fracture rates among elderly Hong Kong Chinese subjects are approximately half of those of American, Australian, and Canadian subjects. Data synthesis suggests elderly Caucasians have a higher degenerative spondylolisthesis prevalence, being approximately 70% higher than that of elderly Hong Kong Chinese. Literature review of other authors' publications shows, compared with Caucasians, Chinese have a much lower incident rate of back pain. We conclude that elderly Chinese have a generally healthier spine relative to elderly Caucasians.

ZERO-PROFILE DEVICE IMPLANTATION IN ANTERIOR CERVICAL DISCECTOMY AND FUSION: A SINGLE INSTITUTE EXPERIENCE

Background: A surgical procedure, anterior cervical discectomy and fusion (ACDF), is used for neural decompression in degenerative cervical disk disease and cervical spondylosis. A new type of cervical interbody cage, the Zero-profile device (ZPD), has been developed which could reduce postoperative complications among patients.&#x0D; Objectives: The study aimed to examine the effect of ZPD on clinical outcomes and cervical spine alignment of enrolled patients at 1-year follow-up in the management of ADCF.&#x0D; Methods: This study retrospectively evaluated the clinical and radiographic outcomes using the Zero-profile device (ZPD) in the anterior cervical discectomy and fusion (ACDF). All patients who underwent ACDF at Vajira Hospital between May 2017 and June 2021 were included in this study. Radiographic images obtained from picture archiving and communication systems (PACS) were used to evaluate the device-level Cobb angle (DLCA), segmental Cobb angle (SCA), global Cobb angle (GCA), sagittal vertical axis (SVA), and intervertebral disk height. The Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) were obtained from the patients’ medical records. The preoperative DLCA, SCA, GCA, SVA, and intervertebral disk height measurements were compared with the postoperative measurements at 1 year.&#x0D; Results: A total of 31 patients (45 disks) who underwent ACDF with the ZPD were included in this study. A significant improvement was found in JOA, VAS, DLCA, SCA, GCA, SVA, and intervertebral disk height after ACDF with ZPD (p&lt;0.001). Immediate postoperative dysphagia occurred in two patients (6.5%), which resolved after 3 months. No subsidence was reported at 1-year follow-up. Age, BMI as well as the preoperative cervical alignment did not affect outcomes in this study.&#x0D; Conclusion: The use of the ZPD in ACDF improved clinical and radiographic outcomes in the correction of cervical spine alignment, and minimized postoperative complications of dysphagia. No device-related failure occurred, and favorable outcomes persisted at 1-year follow-up.

Fragility Fractures in Postmenopausal Women: Development of 5-Year Prediction Models Using the FRISBEE Study.

ContextIndividualized fracture risk may help to select patients requiring a pharmacological treatment for osteoporosis. FRAX and the Garvan fracture risk calculators are the most used tools, although their external validation has shown significant differences in their risk prediction ability.Objective and MethodsUsing data from the Fracture Risk Brussels Epidemiological Enquiry study, a cohort of 3560 postmenopausal women aged 60 to 85 years, we aimed to construct original 5-year fracture risk prediction models using validated clinical risk factors (CRFs). Three models of competing risk analysis were developed to predict major osteoporotic fractures (MOFs), all fractures, and central fractures (femoral neck, shoulder, clinical spine, pelvis, ribs, scapula, clavicle, sternum).ResultsAge, a history of fracture, and hip or spine BMD were predictors common to the 3 models. Excessive alcohol intake and the presence of comorbidities were specific additional CRFs for MOFs, a history of fall for all fractures, and rheumatoid arthritis for central fractures. Our models predicted the fracture probability at 5 years with an acceptable accuracy (Brier scores ≤ 0.1) and had a good discrimination power (area under the receiver operating curve of 0.73 for MOFs and 0.72 for central fractures) when internally validated by bootstrap. Three simple nomograms, integrating significant CRFs and the mortality risk, were constructed for different fracture sites. In conclusion, we derived 3 models predicting fractures with an acceptable accuracy, particularly for MOFs and central fractures. The models are based on a limited number of CRFs, and we constructed nomograms for use in clinical practice.

Relationship Among the Foraminal Area and Demographic and Clinical Characteristics of Patients with Low Back Pain

Our study aims to contribute to existing knowledge by evaluating patients with low back pain to provide a more accurate relationship between the diameter of the intervertebral foramen and the clinical, demographic, and lumbar spine anatomic factors such as age, sex, body mass index, the Zurich Claudication Questionnaire, facet joint, intervertebral disc, ligamentum flavum, and spinal canal. We studied 90 consecutive patients who had undergone evaluation for low back pain. We used magnetic resonance imaging to assess the cross-sectional areas of the intervertebral foramina at each level of the lumbar spine together with the ligamentum flavum area and the dural sac cross-sectional area (DSCSA) measurements. The presence of disc and facet joint degeneration was evaluated and data on symptoms were obtained. Age (P < 0.0001), lumbar disc degeneration grade (P= 0.016), and DSCSA (P < 0.0001) were found to statistically significantly influence the foraminal area (FA). The mean FA at all lumbar levels increased with increasing DSCSA. The mean FA decreased with age at all levels except L5/S1. Lumbar disc degeneration grade 1-3 increased the mean FA at L5/S1, but not at other levels. No statistically significant effects of the side of the measurement, sex, body mass index, Zurich Claudication Questionnaire score, ligamentum flavum area, or facet joint degeneration were found. The results of the present study allow us to quantify the effect of age, DSCSA, and lumbar disc degeneration grade on the FA.

Proton Density Fat Fraction Spine MRI for Differentiation of Erosive Vertebral Endplate Degeneration and Infectious Spondylitis

Vertebral Modic type 1 (MT1) degeneration may mimic infectious disease on conventional spine magnetic resonance imaging (MRI), potentially leading to additional costly and invasive investigations. This study evaluated the diagnostic performance of the proton density fat fraction (PDFF) for distinguishing MT1 degenerative endplate changes from infectious spondylitis. A total of 31 and 22 patients with equivocal diagnosis of MT1 degeneration and infectious spondylitis, respectively, were retrospectively enrolled in this IRB-approved retrospective study and examined with a chemical-shift encoding (CSE)-based water-fat 3D six-echo modified Dixon sequence in addition to routine clinical spine MRI. Diagnostic reference standard was established according to histopathology or clinical and imaging follow-up. Intravertebral PDFF [%] and PDFFratio (i.e., vertebral endplate PDFF/normal vertebrae PDFF) were calculated voxel-wise within the single most prominent edematous bone marrow lesion per patient and examined for differences between MT1 degeneration and infectious spondylitis. Mean PDFF and PDFFratio of infectious spondylitis were significantly lower compared to MT1 degenerative changes (mean PDFF, 4.28 ± 3.12% vs. 35.29 ± 17.15% [p < 0.001]; PDFFratio, 0.09 ± 0.06 vs. 0.67 ± 0.37 [p < 0.001]). The areas under the curve (AUC) and diagnostic accuracies were 0.977 (p < 0.001) and 98.1% (cut-off at 12.9%) for PDFF and 0.971 (p < 0.001) and 98.1% (cut-off at 0.27) for PDFFratio. Our data suggest that quantitative evaluation of vertebral PDFF can provide a high diagnostic accuracy for differentiating erosive MT1 endplate changes from infectious spondylitis.

Fracture risk across a wide range of physical activity levels, from sedentary individuals to elite athletes.

To examine how physical activity is associated with risk of different fracture outcomes across the full range of physical activity. By combining information from three cohort studies and using generalized structural equation modelling, we estimated a continuous unitless latent variable reflecting physical activity that ranged from sedentary through elite athlete levels. Associations between physical activity and fracture outcomes were assessed with proportional hazards regression using restricted cubic splines with the mean physical activity (corresponding to 20-40min walking or bicycling/day or 2-3h exercise/week) as reference. Among 63,980 men and women (49-68years) and during 13years of follow-up, 8506 fractures occurred, including 2164 distal forearm, 779 proximal humerus, 346 clinical spine, and 908 hip fractures. Both lower and higher physical activity was associated with higher risk of any fracture compared to the mean. Physical activity at 1 standard deviation (SD) below the mean, corresponding to walking/bicycling <20min/day or exercising <1-1h/week, was associated with a lower risk of distal forearm fracture (hazard ratio [HR]: 0.92, 95% confidence interval [CI]: 0.85-0.99) and higher risk of hip fracture (HR: 1.24, 95% CI: 1.13-1.37), but no associations were seen above the mean physical activity level for these fractures. Physical activity was not associated with proximal humerus fracture but had a possible U-shaped association with clinical spine fracture. Physical activity was non-linearly associated with fracture risk and the association differed across fracture sites. Up to 2-3h weekly exercise is beneficial for the prevention of hip fracture but may increase the risk of distal forearm fracture.

Computational Analysis of Vertebral Body for Compression Fracture using Texture and Shape Features

The primary goal in this paper is to automate radiological measurements of Vertebral Body (VB) in Magnetic Resonance Imaging (MRI) spinal scans. It starts by preprocessing the images, then detect and localize the VB regions, next segment and label VBs and finally classify each VB into three cases as being normal or fractured in case 1, benign or malignant in case 2 and normal, benign or malignant in case 3. The task is accomplished by extracting and combining distinct features of VB such as boundary, gray levels, shape and texture features using various Machine Learning techniques. The class balance deficit dataset towards normal and fractures is balanced by data augmentation which provides an enriched dataset for the learning system to perform precise differentiation between classes. On a clinical spine dataset, the method is tested and validated on 535 VBs for segmentation attaining an average accuracy 94.59% and on 315 VBs for classification with an average accuracy of 96.07% for case 1, 93.23% for case 2 and 92.3% for case 3.

Computational Analysis of Vertebral Body for Compression Fracture Using Texture and Shape Features

The primary goal in this paper is to automate radiological measurements of Vertebral Body (VB) in Magnetic Resonance Imaging (MRI) spinal scans. It starts by preprocessing the images, then detect and localize the VB regions, next segment and label VBs and finally classify each VB into three cases as being normal or fractured in case 1, benign or malignant in case 2 and normal, benign or malignant in case 3. The task is accomplished by extracting and combining distinct features of VB such as boundary, gray levels, shape and texture features using various Machine Learning techniques. The class balance deficit dataset towards normal and fractures is balanced by data augmentation which provides an enriched dataset for the learning system to perform precise differentiation between classes. On a clinical spine dataset, the method is tested and validated on 535 VBs for segmentation attaining an average accuracy 94.59% and on 315 VBs for classification with an average accuracy of 96.07% for case 1, 93.23% for case 2 and 92.3% for case 3.

Use of Patient-Reported Outcomes Measurement Information System (PROMIS) measures to characterise health status for patients seeking care from an orthopaedic provider: a retrospective cohort study

ObjectivesCharacterise the health status of patients newly consulting an orthopaedic specialist across eight clinical subspecialties.DesignRetrospective cohort.Setting18 orthopaedic clinics, including 8 subspecialties (14 ambulatory and 4 hospital based) within an academic...

3D printed personalized lumbar spinal fusion device design and biomechanical performance analysis

The finite element analysis method was used to compare the biomechanical performance of the individualized interbody fusion cage, the clinically common double bullet type fusion cage and the healthy lumbar spine model under different working conditions. According to the CT scan data of the lumbar spine of a real healthy human body, a finite element model of the lumbar spine of a healthy human body was designed using finite element software as a normal control group. On this basis, the individualized lumbar fusion cage model and the clinical standard bullet type fusion cage lumbar spine model were further established. These three finite element models were applied with different loads such as vertical compression, forward flexion, extension, and lateral bending to observethe changes in the stress distribution and stress magnitude of each component of the lumbar spine. The maximum stress values of the vertebral body and the fusion cage under the extension condition in the clinical standard bullet type fusion cage lumbar spine model were 45.81 MPa and 97.07 MPa, respectively. The stress of the vertebral body and the fusion cage in the individualized lumbar fusion cage model was closer to the stress of the vertebral body and the intervertebral disc in the healthy lumbar spine model. From the perspective of displacement, the displacement of each component of the lumbar spine models of the two fusion cages was smaller than that of the healthy lumbar spine model, indicated that the internal fixation of the fusion cage limited the range of motion of the vertebral body. On the other hand, it also confirmed the validity of the finite element model established in the study. The displacement of the fusion cage and the vertebral body in the individualized model under different working conditions was generally smaller thanthat of the standard model fusion cage and the vertebral body. The fusion cage can replace the diseased intervertebral disc to a certain extent, so as to reduce the patient's pain and restore the lumbar function. The personalized design of the fusion cage can better meet the needs of individual patients, which has the great significance to the recovery of the patient's lumbar spine function, the service life of the fusion cage and the protection of the contact vertebral body, and provides certain guidance for actual clinical treatment.

One- and 2-year incidence of osteoporotic fracture: a multi-cohort observational study using routinely collected real-world data

SummaryWe estimated and characterized the imminent fracture risk (1–2 years) of high-risk fracture patients through a multinational (UK, Spain, Denmark) cohort study. Older individuals with newly diagnosed osteoporosis and individuals who had a fracture while on treatment with a bisphosphonate were at a high risk of imminent fracture.PurposeTo characterize and estimate 1- to 2-year fracture risk in high-risk fracture patients.MethodsMulti-cohort study in (database/study period) UK (CPRD/1995–2017), Spain (SIDIAP/2006–2016) and Denmark (DHR/1995–2016) including individuals ≥ 50 years old in NDO (newly diagnosed osteoporosis), OFx (incident osteoporotic fracture), BP (incident oral bisphosphonates use) or FWOT (fracture while on treatment with bisphosphonates). Outcomes (ICD-10/READ): hip, clinical spine, non-hip, non-spine and hip/humerus/distal forearm fracture. Follow-up: from cohort entry until death, migration/transfer or end of the study. Statistics: baseline characteristics and incidence rate (IR per 1000 persons).Results (1-year IR)NDO included 69,899 (UK), 37,901 (Spain) and 158,191 (Denmark) individuals. Spanish-IR was lowest for hip (4.7), clinical spine (2.5) and major osteoporotic fracture (MOF) (17.3) and highest in Denmark (74.2, 26.0 and 120.1, respectively). OFx included 83,514 (UK), 51,044 (Spain) and 509,551 (Denmark) individuals. IR in Denmark was highest for hip (24.1) and MOF (47.2), in Spain was highest for the clinical spine (9.4) and lowest for hip (9.5) and in the UK was lowest for the clinical spine (2.8) and MOF (20.7). BP included 148,507 (UK), 52,037 (Spain) and 204,010 (Denmark) individuals. Spanish-IR was lowest for hip (5.0) and MOF (21.1) and highest in Denmark (20.3 and 48.6, respectively). FWOT included 28,930 (UK), 1,865 (Spain) and 31,882 (Denmark) individuals. Clinical spine-IR was highest for Spain (12.0). Hip-IR was lowest for Spain (7.6) and highest for Denmark (33.6). Comparing young subjects, those who have FWOT started with an increased fracture rate.ConclusionOFx and FWOT individuals experience higher re-fracture incidence rates than those with osteoporosis with or without treatment.