Fresh Vertebral Fractures Research Articles

A Deep-Learning Model for Diagnosing Fresh Vertebral Fractures on Magnetic Resonance Images

BackgroundThe 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 MRI, and fall short in localizing the fracture sites. PurposeThis study aimed to evaluate the efficacy of a deep learning model, based on artificial intelligence (AI), for identifying and localizing fresh VFs on MRI, with the intent to enhance diagnostic accuracy, sensitivity, and specificity. MethodsThis 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. ResultsThe 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%. ConclusionOur findings highlighted the potential of AI in diagnosing fresh VFs, offering an accurate and efficient way to aid physicians with diagnosis and treatment decisions.

Therapeutic Prediction of Osteoporotic Vertebral Compression Fracture Using the AO Spine-DGOU Osteoporotic Fracture Classification and Classification-Based Score: A Single-Center Retrospective Observational Study.

The treatment of osteoporotic vertebral compression fractures (OVCFs) is based on their severity; however, an efficient prediction tool is lacking. We aimed to evaluate the validity of the osteoporotic fracture classification (OF classification) and scoring system (OF score) in predicting the treatment strategy for patients with OVCF, defined according to the Japanese criteria. We retrospectively investigated 487 consecutive patients diagnosed with vertebral body fractures between January 2018 and December 2022. Only patients with their fresh vertebral fracture episode during the study period were included. Patients were classified into 3 groups: conservative treatment, balloon kyphoplasty (BKP), and open surgery. OF classification and OF scores were assessed for each patient. A total of 237 patients with OVCF were included. There were 127, 81, and 29 patients in the conservative, BKP, and open surgery groups, respectively. The OF score was significantly higher in the BKP and open surgery groups than in the conservative group (p < 0.001). Multivariate logistic regression analysis showed that antiosteoporotic drug use, OF classification, progressive deformity, neurological symptoms and mobilization were independent risk factors for operative treatment (all p < 0.001). Receiver operating characteristic analysis showed that the cutoff OF score for operative indication was 5.5, with a sensitivity of 91.9%, specificity of 56.5%, and area under the curve of 0.820 (95% confidence interval, 0.769-0.871). The OF score identified patients who required operative treatment with a high degree of accuracy. This is especially important for ruling out patients who definitely require operative treatment.

Efficacy of Three Teriparatide Preparations and Romosozumab, Osteogenesis Promoters, in the Treatment of Fresh Vertebral Fractures: A Retrospective Observational Study.

In Japan, daily, twice weekly, and weekly formulations of teriparatide (TPD) and monthly formulations of romosozumab (ROMO) are available as osteogenesis promoters for the treatment of osteoporosis with a high risk for fracture. To compare the effects of three TPD preparations and ROMO on fracture healing and low back pain after a fresh vertebral fracture. This was a retrospective observational study. Patients presenting with fresh osteoporotic vertebral fractures were treated subcutaneously with TPD daily (DTPD), twice weekly (2/WTPD), weekly (WTPD), or with ROMO monthly. Bone union, vertebral height changes, and low back pain in the injured vertebra were compared after 6months of treatment. Bone union and pain improvement were more frequent among those who received daily and twice weekly administration of TPD compared with those who received WTPD and ROMO administration. A comparison for multiplicity between the groups using the Steel-Dwass test showed significant differences between the DTPD and ROMO groups (p = 0.0029) and WTPD and ROMO groups (p = 0.0490), suggesting superior bone fusion in the DTPD and WTPD groups. Similarly, significant differences were noted between the DTPD and ROMO groups (p = 0.0001), WTPD and ROMO groups (p = 0.0341), and 2/WTPD and ROMO groups (p = 0.0009), indicating a higher degree of pain improvement in the DTPD, WTPD, and 2/WTPD groups compared with that in the ROMO group. Daily, weekly, and twice-weekly administration of TPD may be superior to ROMO for promoting fresh vertebral fracture healing.

Diagnostic value of SPECT/CT bone imaging in fresh osteoporotic vertebral compression fractures.

To investigate the diagnostic value of single photon emission computed tomography/computed tomography (SPECT/CT) bone imaging in fresh osteoporotic vertebral compression fractures. The imaging data of 30 patients with osteoporosis (10 males and 20 females; aged 50~93 years) who received SPECT/CT bone imaging and spinal magnetic resonance imaging (MRI) in our hospital from June 2018 to June 2021 were analyzed retrospectively. Single photon emission tomography/CT bone imaging and spinal MRI were analyzed by two experienced specialists. Kappa consistency test and pairing were used for the diagnostic results of the two groups χ2 test (McNemar test) for statistical analysis. Fifty one vertebral fractures were detected in 30 patients, including 41 fresh vertebral fractures and 10 old vertebral fractures by SPECT/CT bone imaging; MRI revealed 40 fresh vertebral fractures and 11 old vertebral fractures. Single photon emission tomography/CT bone imaging and spinal MRI had good consistency in the diagnosis of fresh osteoporotic vertebral compression fractures (Kappa=0.820, P<0.001), and there was no significant difference between the two imaging methods in the diagnosis of osteoporotic vertebral fractures (P=1.000). The value of SPECT/CT in the localization and characterization of osteoporotic fresh vertebral compression fractures is similar to that of MRI. At the same time, SPECT/CT can also find some bone lesions that cannot be displayed by conventional MRI. Especially when patients have MRI contraindications, SPECT/CT bone imaging can be used as the preferred imaging method.

The Impact of Geometrical Spinal Shape on Fresh Vertebral Fractures in Elderly Volunteers: A Longitudinal Cohort Analysis.

Four-year, longitudinal cohort study. The aim of this study was to investigate the effect of original spinal shape on incidental vertebral fractures (VFs) and to identify the influence of changes in pre- and post-fracture geometrical spinal shape. Clinical evidence demonstrates that VFs cause spinal kyphosis, morbidities, and deteriorating quality of life in elderly people. However, knowledge of geometrical spinal shapes that affect incidental VFs is limited. Three hundred seventeen volunteers underwent whole spine radiography as part of a health screening in both 2012 and 2016. We extracted volunteers with incidental VF in 2016. Sex- and age-matched volunteers without VF were enrolled as controls. Baseline demographic variables, geometrical spinal shape, and spinopelvic parameters were compared between the two groups. In volunteers with incidental VF, we investigated the association between baseline spinal shape and post-fracture shape. Twenty-seven volunteers (12 men; mean age 75.4 ± 5.4 and 15 women; mean age 71.6 ± 7.9) with VF were enrolled, and 175 volunteers (48 men, 127 women) without VF were selected as controls. In men with VF, the thoracic kyphosis apex was located significantly more posteriorly and caudally than in those without VF. In women with VF, the lordosis apex was located significantly more posteriorly and caudally than in those without VF. After fractures occurring above the inflexion vertebra, the low anterior apex spine (L5) changed its geometrical shape in that the posterior apex and the inflexion vertebra shifted significantly more posteriorly compared to the high anterior apex spine (L4/5). Original geometrical spinal shape affected the occurrence of VF, and post-fracture spinal shape depended on the positional relationship between the inflexion vertebra and fractured vertebra. Our study helps to understand the influence of geometrical spinal shape on the risks of VF. 3.

P52. Manipulative reduction combined with concave side percutaneous kyphoplasty for treatment of kyphoscoliosis deformity caused by thoracolumbar osteoporotic vertebral compression fracture

BACKGROUND CONTEXT Local kyphoscoliosis deformity caused by coronal asymmetric vertebral compression fracture due to osteoporosis is very rare. As far as we know, there are no related reports. PURPOSE To evaluate the efficacy and safety of manipulative reduction combined with concave side percutaneous kyhphoplasty (PKP) in the treatment of kyphoscoliosis deformity caused by thoracolumbar osteoporotic vertebral compression fractures (OVCF). STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE Twenty-eight thoracolumbar OVCF patients with coronal asymmetric compression fractures from January 2016 to January 2017. OUTCOME MEASURES The visual analog score (VAS), Oswestry Disability Index (ODI), Cobb angle of local kyphosis and scoliosis of local spine. METHODS A retrospective analysis of 28 thoracolumbar OVCF patients with coronal asymmetric compression fractures admitted to our hospital from January 2017 to January 2018 was conducted, including 10 male and 18 female patients, with an average age of 68.3±5.5 years. Preoperative CT or X-ray confirmed lateral and anterior compression fracture of vertebral body, and MRI suggested fresh vertebral fracture. All patients underwent extension and reverse lateral flexion position to reduce preoperatively, and concave side PKP under local anesthesia. The VAS, ODI, Cobb angle of local kyphosis and scoliosis were recorded before the surgery, at 1 day after operation and at the last follow-up. RESULTS Surgery of all patients went successfully, with an average follow-up of 16.1 ± 3.4 months. Before and 1 day after surgery, and at the last follow-up, the patient's VAS scores were 8.3±0.6, 2.5±0.6, and 2.2±0.4, respectively, and the ODI scores were 48.5±8.7, 20.2±5.6, and 18.6±5.5, respectively. The VAS and ODI score were significantly improved at 1 day after surgery and at the last follow-up (P 0.05). Before and 1 day after surgery, and at the last follow-up, the Cobb angles of local kyphosis of the injured vertebrae were 23.4±2.3°, 10.7±.1.8°, and 11±2.5°, and the Cobb angles of the scoliosis were 10.5±1.7° and 3.2±2.2°, and 4.1±2.4°, respectively. The kyphosis and scoliosis Cobb angle were significantly improved at 1 day after the surgery and at the last follow-up (P 0.05). During the operation, one case occurred cement leakage in front of vertebral body, and 2 cases had concave side cement leakage, all of which did not lead to any clinical symptom. No new vertebral fractures occurred during the follow-up period. CONCLUSIONS Manipulative reduction combined with concave side PKP is a safe and effective method for the treatment of kyphoscoliosis deformity caused by thoracolumbar OVCF. It can effectively relieve pain, improve the quality of life and improve local kyphoscoliosis deformity of local spine. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Effectiveness of monotherapy and combined therapy with calcitonin and minodronic acid hydrate, a bisphosphonate, for early treatment in patients with new vertebral fractures: An open-label, randomized, parallel-group study.

Evidence related to the effectiveness of combination drug therapy for the treatment of osteoporosis is currently considered insufficient. Therefore, this study was performed to clarify the effects of monotherapy, and combination therapy, with a bisphosphonate (minodronic acid hydrate), a bone resorption inhibitor, and calcitonin (elcatonin), which is effective for the alleviation of pain due to vertebral fractures in osteoporotic patients. Study participants comprised of 51 female subjects with post-menopausal osteoporosis, whose main complaint was acute lower back pain caused by vertebral fractures. Subjects were randomly allocated into three groups and then administered with either intramuscular injections of elcatonin at a dose of 20 units weekly, minodronic acid hydrate at a dose of 1mg daily, or a combination of these two drugs. As primary endpoints, time-dependent changes in levels of pain were assessed using a visual analog scale from baseline to 6 months of duration. In addition, we examined the effects of monotherapies, and a combination therapy on bone resorption, with changes in bone mineral density at 4 sites and advanced hip assessment parameters from baseline to 6 months. A two-tailed significance level of 5% was used for hypothesis testing. Elcatonin monotherapy showed some alleviation of pain immediately after any vertebral fractures, which was more than in the minodronic acid hydrate monotherapy group. In addition, the minodronic acid hydrate monotherapy group experienced more effective inhibited bone resorption than the elcatonin monotherapy group. In the combination therapy, the efficacy for alleviating pain and inhibiting bone resorption was equivalent to the effect observed in the elcatonin and minodronic acid hydrate monotherapy groups respectively, with further improved values of bone mineral density observed in the femoral neck and lumbar vertebrae, and in parameters of advanced hip assessment compared with both monotherapy groups. Combination therapy with elcatonin and minodronic acid hydrate appears to be an effective treatment for osteoporosis patients with lower back pain, caused by fresh vertebral fractures.

Additive effect of elcatonin to risedronate for chronic back pain and quality of life in postmenopausal women with osteoporosis: a randomized controlled trial

Calcitonin has been reported to reduce acute and chronic back pain in osteoporotic patients. The additive effect of calcitonin with a bisphosphonate on chronic back pain remains unclear. The purpose of this study was to evaluate the effect of combining elcatonin (eel calcitonin) with risedronate for patients with chronic back pain. Forty-five postmenopausal women diagnosed as having osteoporosis with chronic back pain persisting for more than 3 months, after excluding women with fresh vertebral fractures within the last 6 months, were randomly allocated to a risedronate group (risedronate alone, n = 22) and a combined group (risedronate and elcatonin, n = 23). The study period was 6 months. Pain was evaluated with a visual analogue scale (VAS) and the Roland-Morris questionnaire (RDQ). Back extensor strength, bone mineral density, and quality of life on the SF-36 and the Japanese osteoporosis quality of life score were also evaluated. Significant improvements were found in the combined group for VAS at final follow-up compared with baseline and 3 months, mental health status on the SF-36, and JOQOL domains for back pain and general health. The JOQOL domain for back pain improved significantly, but no change was found in the VAS or other domains in the risedronate group. Bone mineral density increased significantly in the two groups, but no significant difference was found between the groups. Back extensor strength did not change in both groups. In conclusion, the use of elcatonin in addition to risedronate for more than 3 months reduced chronic back pain. The additional therapy of risedronate with elcatonin may be a useful and practical choice for the treatment of osteoporosis with chronic back pain persisting more than 3 months.

Less invasive reduction and fusion of fresh A2 and A3 traumatic L1–L4 fractures with a novel vertebral body augmentation implant and short pedicle screw fixation and fusion

The aim of this clinical study was to report on the efficacy in reduction and safety in PMMA leakage of a novel vertebral augmentation technique with PEEK and PMMA, together with pedicle screws in the treatment of fresh vertebral fractures in young adults. Twenty consecutive young adults aged 45±11years with fresh burst A3/AO or severely compressed A2/AO fractures underwent via a less invasive posterior approach one-staged reduction with a novel augmentation implant and PMMA plus 3-vertebrae pedicle screw fixation and fusion. Radiologic parameters as segmental kyphosis (SKA), anterior (AVBHr) and posterior vertebral body height ratio (PVBHr), spinal canal encroachment (SCE), cement leakage and functional parameters as VAS, SF-36 were measured pre- and post-operatively. Hybrid construct restored AVBHr (P<0.000), PVBHr (P=0.02), SKA (P=0.015), SCE (P=0.002) without loss of correction at an average follow-up of 17months. PMMA leakage occurred in 3 patients (3 vertebrae) either anteriorly to the fractured vertebral body or to the adjacent disc, but in no case to the spinal canal. Two pedicle screws were malpositioned (one medially, one laterally to the pedicle at the fracture level) without neurologic sequelae. Solid posterolateral spinal fusion occurred 8-10months post-operatively. Pre-operative VAS and SF-36 scores improved post-operatively significantly. This study showed that this novel vertebral augmentation technique using PEEK implant and PMMA reduces and stabilizes via less invasive technique A2 and A3 vertebral fractures without loss of correction and leakage to the spinal canal.

Characteristic Radiographic or Magnetic Resonance Images of Fresh Osteoporotic Vertebral Fractures Predicting Potential Risk for Nonunion

Prospective multicenter study. To identify radiographic or magnetic resonance (MR) images of fresh vertebral fractures that can predict a high risk for delayed union or nonunion of osteoporotic vertebral fractures (OVFs). Vertebral body fractures are the most common fractures in osteoporosis patients. Conservative treatments are typically chosen for OVFs, and associated back pain generally subsides within several weeks with residual persistent deformity of the vertebral body. In some patients, OVF healing is impaired and correlated with prolonged back pain. However, assessments such as plain radiograph or MR images taken during the early phase to predict high risks for nonunions of OVFs and/or poor prognoses have not been identified. A total of 350 OVF patients from 25 institutes were enrolled in this clinical study. Plain radiograph and MR images of the OVFs were routinely taken at enrollment at the respective institutes. The findings on the plain radiograph and MR images were classified after enrollment in the study. All the patients were treated conservatively without any surgical intervention. After a 6-month follow-up, the patients were classified into two groups, a union group and a nonunion group, depending on the presence of an intravertebral cleft on plain radiograph or MR images. The associations of the images from the first visit with those of the corresponding nonunions at the 6-month follow-up were analyzed by multivariate logistic regression to elucidate specific image characteristics that may predict a high risk for nonunion of OVFs. Forty-eight patients (49 vertebrae) among the 350 patients (363 vertebrae) were classified as nonunions, indicating a nonunion incidence of 13.5% for conventional conservative treatments for OVFs. The statistical analyses revealed that a vertebral fracture in the thoracolumbar spine, presence of a middle-column injury, and a confined high intensity or a diffuse low intensity area in the fractured vertebrae on T2-weighted MR images were significant risk factors for nonunion of OVFs. The results of this study revealed significant relationships between plain radiograph and MR images of acute phase OVFs and the incidence of nonunion. As these risk factors are defined more clearly and further validated, they may become essential assessment tools for determining subsequent OVF treatments. Patients with one or more of the earlier-described risk factors for nonunion should be observed carefully and provided with more intensive treatments.

Nerve root syndromes after fresh vertebral fracture

Nerve root syndromes after fresh vertebral fracture

Calcitonin

Calcitonin is a polypeptide hormone that bone resorption-inhibitory and analgesic effects, and has been used over many decades as a drug for the treatment of osteoporosis in Japan and overseas. Reports of large-scale studies of this hormone therefore as yet are few, compared to recently introduced drugs. Calcitonin is prescribed in injectable form in Japan while nasal spray preparations are widely used in Europe and the Unites States. Its characteristic effect of analgesia is slow in onset as compared with anti-inflammatory analgesic agents. A mechanism of action involving its serotonin receptor expression-mediated effect on pain impulse transmission has been demonstrated. On account of this effect, calcitonin is recommended for use in the management of pain in patients with fresh vertebral fractures.

Complications and safety aspects of kyphoplasty for osteoporotic vertebral fractures: a prospective follow-up study in 102 consecutive patients

BackgroundKyphoplasty represents an established minimal-invasive method for correction and augmentation of osteoporotic vertebral fractures. Reliable data on perioperative and postoperative complications are lacking in the literature. The present study was designed to evaluate the incidence and patterns of perioperative complications in order to determine the safety of this procedure for patients undergoing kyphoplasty.Patients and MethodsWe prospectively enrolled 102 consecutive patients (82 women and 20 men; mean age 69) with 135 operatively treated fractured vertebrae who underwent a kyphoplasty between January 2004 to June 2006. Clinical and radiological follow-up was performed for up 6 months after surgery.ResultsPreoperative pain levels, as determined by the visual analogous scale (VAS) were 7.5 +/- 1.3. Postoperative pain levels were significantly reduced at day 1 after surgery (VAS 2.3 +/- 2.2) and at 6-month follow-up (VAS 1.4 +/- 0.9). Fresh vertebral fractures at adjacent levels were detected radiographically in 8 patients within 6 months. Two patients had a loss of reduction with subsequent sintering of the operated vertebrae and secondary spinal stenosis. Accidental cement extravasation was detected in 7 patients in the intraoperative radiographs. One patient developed a postoperative infected spondylitis at the operated level, which was treated by anterior corporectomy and 360 degrees fusion. Another patient developed a superficial wound infection which required surgical revision. Postoperative bleeding resulting in a subcutaneous haematoma evacuation was seen in one patient.ConclusionThe data from the present study imply that percutaneous kyphoplasty can be associated with severe intra- and postoperative complications. This minimal-invasive surgical procedure should therefore be performed exclusively by spine surgeons who have the capability of managing perioperative complications.

Sequential Changes of Bone Metabolism in Normal and Delayed Union of the Spine

Time-dependent changes in bone markers in delayed or nonunion of vertebral fracture were compared with those of normal union. Thirty-three patients with a fresh vertebral fracture were enrolled. Urinary Type I collagen C-terminal telopeptide, pyridinoline, deoxypyridinoline, serum C-terminal telopeptide, and N-midportion of osteocalcin (OC(N-mid)) were determined at the time of hospital admission (within 24 hours after the fracture event in all cases) and at 2, 4, 12, 24, and 48 weeks thereafter. Subjects were divided into two groups according to the results of MR images taken 48 weeks after fracture. Twenty-four were normally united (Group N) and nine had delayed or nonunion (Group D) of the spine. No differences between values of bone resorption markers in Group N and Group D were observed at any time. Serum OC(N-mid) in Group N started to increase at 2 weeks and reached the peak value at 24 weeks (180%); however, serum OC(N-mid) in Group D increased at most 120% from baseline to 4 weeks. Values of serum OC(N-mid) in Group N were higher at 24 and 48 weeks than those in Group D. Impairment of fracture healing was strongly associated with a deficit in the increase of osteocalcin in the later stage of fracture repair. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Sitting-Supine Position Radiography for Early Detection of Fresh Vertebral Fracture in the Elderly

Sitting-Supine Position Radiography for Early Detection of Fresh Vertebral Fracture in the Elderly

99Tcm-HMPAO-labelled leucocytes for bone marrow scintigraphy and evaluation of skeletal lesions. Comparison with 99Tcm-HSA colloid results

Bone marrow scintigrams obtained 2-6 h and/or 20-24 h after injection of 99Tcm-HMPAO-labelled leucocytes (LeuSc) in 16 patients (seven males, nine females, average age 57 years, either with benign or malignant haemopathy, or with benign or metastatic skeletal diseases) have been compared to corresponding pictures obtained 20 min after injection of 99Tcm-labelled human serum albumin nanosized colloids (NanSc, performed within a week thereafter). Overall distribution of the colloids and of the labelled leukocytes at the level of the bone marrow appeared to be the same. Fresh vertebral fractures as well as metastatic lesions of the axial skeleton appeared as cold defects in both investigations. Fractures of the ribs as well as one metastatic lesion involving one trochanter could not be identified. Although all seven lesions involving Th9 to L4 could be clearly investigated with LeuSc, only three could be recognized with NanSc. It is concluded that, in patients with cancerous diseases, LeuSc is better than NanSc in demonstrating lesions in the case of dubious conventional osseous scintigrams as well as in the case of neurological or skeletal symptoms at the level of the lumbar and/or low thoracic regions.