Vertebral Height Research Articles

Safety and Efficacy of Denosumab in Children With Osteogenesis Imperfecta-the First Prospective Comparative Study.

Denosumab is a potential therapeutic agent for osteogenesis imperfecta (OI), but its efficacy and safety remain unclear in children with OI. We aimed to investigate the effects of denosumab on bone mineral density (BMD), spinal morphometry, and safety in children with OI compared with zoledronic acid. In this prospective study, 84 children or adolescents with OI were randomized to receive denosumab subcutaneous injection every 6 months or zoledronic acid intravenous infusion once. Changes of BMD and its Z-score, vertebral shape, serum levels of calcium and bone turnover biomarkers were assessed during the 1-year treatment. After 12 months of treatment, BMD at the lumbar spine, femoral neck, and total hip significantly increased by 29.3%, 27.8%, and 30.2% in the denosumab group, and by 32.2%, 47.1%, and 41.1% in the zoledronic acid group (all P < .001 vs baseline). Vertebral height and projection area significantly increased after denosumab and zoledronic acid treatment. Rebound hypercalcemia was found to be a common and serious side effect of denosumab, of which 14.3% reached hypercalcemic crisis. Rebound hypercalcemia could be alleviated by switching to zoledronic acid treatment. Treatment with denosumab or zoledronic acid is beneficial in increasing BMD and improving the spinal morphometry of children with OI. However, denosumab should be used with caution in pediatric patients with OI because of its common and dangerous side effect of rebound hypercalcemia. The appropriate dosage and dosing interval of denosumab need to be further explored in children with OI.

Evaluating somatosensory evoked potentials in predicting treatment outcomes for thoracolumbar spinal compression fractures using closed reduction and over-extension techniques.

To evaluate the predictive value of somatosensory evoked potentials (SEPs) for the efficacy of closed reduction combined with over-extension reduction technique (PVP) in managing thoracolumbar spinal compression fractures. Data were collected from 125 patients who underwent closed reduction with PVP and SEP monitoring from February 2021 to July 2023. We evaluated surgery success rates, incidence of bone cement leakage, and patient recovery outcomes including vertebral anterior height, Oswestry Disability Index (ODI), and Cobb angle restoration. SEP results were analyzed to categorize patients into effective and ineffective treatment groups. Differences in SEP waveforms between these groups were examined, and ROC analysis was used to assess the predictive value of these differences. Multivariate logistic regression was employed to identify risk factors affecting treatment efficacy. Post-treatment assessments showed significant improvements in vertebral anterior height, ODI, and Cobb angle. SEP monitoring correlated well with intraoperative findings and physical examinations. During reduction, changes in SEP latency and amplitude were noted in 37 patients, with 7 patients meeting SEP amplitude alarm criteria, which normalized after adjustments. During PVP, 28 patients exhibited SEP amplitude fluctuations and 5 experienced a 30% reduction in amplitude following initial cement injection, with no significant latency changes. Treatment was deemed effective in 93 patients and ineffective in 32. SEP amplitudes during vertebral compression and PVP were significantly lower in the effective group (P<0.05). The AUC for predicting treatment efficacy was 0.819 and 0.859, respectively. Multivariate analysis revealed low preoperative vertebral compression ratio, number of fractures, and abnormal SEP amplitudes as independent risk factors for treatment outcomes. SEP monitoring provides an accurate reflection of spinal cord function during closed reduction with PVP, aiding in predicting treatment safety and efficacy. The use of SEP monitoring is thus recommended for clinical application in this context.

A radiological parametric comparison of low-grade lytic spondylolisthesis to degenerative spondylolisthesis - A retrospective approach to establish its dysplastic origin.

This study aims to compare low-grade lytic spondylolisthesis (LS) and degenerative spondylolisthesis (DS) radiologically. In addition, it seeks to identify underlying similarities between LS and DS. This study included patients with low-grade single-level spondylolisthesis at L4-L5 or L5-S1. They were categorized into LS and DS. Radiological features, including pedicle height, width, transverse, and sagittal angle, as well as anterior vertebral heights (AVH) and posterior vertebral heights (PVH), were measured using T1-weighted magnetic resonance imaging. The study involved 88 patients: 46 in the DS group and 42 in the LS group. In the LS group, the AVH was significantly higher than the posterior height at L4 and L5 (L4 PVH/AVH ratio 0.93 in LS vs. 0.96 in DS; L5 PVH/AVH ratio 0.84 in LS vs. 0.92 in DS), and pedicles were more medially oriented (L4: 19.62° in LS vs. 17.7° in DS; L5: 28.92° in LS vs. 26.47° in DS). In addition, at L5, the pedicle height (10.67 mm in LS vs. 11.48 mm in DS) and width (13.56 mm in LS vs. 14.37 mm in DS) were smaller compared to the DS group. Low-grade LS shows distinct radiological vertebral and pedicle anatomy compared to DS. Short and thin pedicles and wedge-shaped vertebrae in LS resemble DS, indicating its dysplastic origin.

Short segment posterior fixation of unstable thoracolumbar vertebral fractures with fractured vertebra augmentation with intermediate pedicle screw - a clinicoradiological analysis.

Unstable thoracolumbar burst fractures are routinely encountered in orthopedic practice. Recently, short-segment fixation with pedicle screw augmentation of the fractured vertebra for unstable thoracolumbar burst fractures has gained popularity. Nonetheless, the maintenance of the kyphotic correction during the follow-up period remains controversial. This study aimed to examine the clinical-radiological outcomes, complications, and functional outcomes of fractured vertebrae augmentation with intermediate pedicle screws in short-segment instrumentation in acute thoracolumbar spine fractures. This retrospective study was conducted in the Department of Orthopedics, All India Institute of Medical Sciences, Jodhpur, using medical records from January 2021 to October 2022. Parameters such as local kyphosis correction, loss of kyphotic correction at final follow-up, anterior body height correction (%), and loss of correction (%) at final follow-up were measured as primary outcomes. Various other parameters such as operative time, blood loss, length of hospital stay, and visual analog scale were measured as secondary outcomes. The mean correction obtained via surgery in the immediate postoperative period was 13.7±2.3 degrees. The mean loss of correction at the final follow-up was 4.1±2.0 degrees, and the mean final local kyphotic angle was 7.2±2.4 degrees (P<0.05). The mean correction obtained via surgery in the immediate postoperative period was 37.2%±9.0%. The mean loss of correction at the final follow-up was 10.5%±5.3%, and the mean final anterior vertebral body height maintained was 72%±11.0% (P<0.05). Short-segment posterior fixation with pedicle screw augmentation achieves good correction of local kyphotic angle and anterior vertebral height in the immediate postoperative period, but some loss of correction at final follow-up is common. In our study, the loss of correction corresponded directly to the load-sharing score.

Effects of Percutaneous Kyphoplasty for the Treatment of Thoracic Osteoporotic Vertebral Compression Fractures with or without Intravertebral Cleft in Elderly Patients.

Few studies have focused on percutaneous kyphoplasty (PKP) in the treatment of thoracic osteoporotic vertebral compression fractures (OVCFs) with intervertebral cleft (IVC). Hence, the objective of this retrospective study was to compare the clinical and radiographic outcomes of PKP in elderly patients with thoracic OVCFs, with or without IVC. A total of 106 patients were enrolled in this study and divided into two groups: the IVC group and the NIVC group (without IVC). Radiographic measures included anterior vertebral height (AVH), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Clinical function measures included Oswestry disability index (ODI) and visual analog scale (VAS) scores. There were no significant differences in the preoperative basic data between the groups classified as IVC and NIVC. However, both groups showed significant improvements in AVH and TK throughout the follow-up periods compared to the preoperative measurements (P<0.05). The recovery of AVH in the IVC group was found to be inferior to that in the NIVC group at 3 years after operation (P<0.05). There were no significant differences in LL, PI, PT and SS in both groups compared with the preoperative results and no statistically significant differences between the two groups at the same follow-up time (P>0.05). The VAS and ODI scores during all follow-up periods were significantly lower than those before operation (P<0.05). At 3 years after operation, the VAS and ODI scores of the IVC group were higher than those of the NIVC group (P<0.05). PKP is an adoptable measure to treat thoracic OVCFs with or without IVC. Our study revealed that the NIVC group was superior to the IVC group in terms of improved vertebral height and pain recovery at long-term follow-up (3 years).

Effectiveness of bone-filled mesh bag technology and angle vertebroplasty in the treatment of osteoporotic thoracic vertebral compression fractures in the elderly.

To evaluate the effectiveness, pain level, and lung function in elderly patients with osteoporotic thoracic vertebral compression fractures using bone filling mesh bag technology compared to curved vertebroplasty. This retrospective analysis reviewed 72 elderly patients with osteoporotic thoracic vertebral compression fractures treated at Xindu District People's Hospital of Chengdu between February 2021 and January 2022. The patients were separated into two groups according to surgery approach: an observation group using bone filling mesh bag technology and a control group using curved vertebroplasty. The overall response rate, pain degree, pulmonary function, life quality grades, surgical indicators, and bone cement leakage rates of the two groups were evaluated. The variation in overall response rate (P=0.420), pain degree (P=0.270), pulmonary function (peak expiratory flow: P=0.660, forced expiratory volume in the first second: P=0.775, forced vital capacity: 0.062), and life quality grades (physical health: P=0.949, social function: P=0.935, physiological function: P=0.970, vitality: P=0.778) between the observation group and the control group after treatment was not statistically meaningful. The Cobb angle (P<0.001) and vertebral height (P<0.001) of patients in the observation group were significantly higher than those in the control group after therapy. The leakage rates of bone cement (intervertebral disc leakage, paravertebral vein leakage, paravertebral soft tissue leakage) of patients in the observation group were notably lower than those in the control group after therapy (P=0.029). Bone filling mesh bag technology offers significant improvements in Cobb angle and vertebral height for treating elderly patients with osteoporotic thoracic vertebral compression fractures, and reduced the leakage rate of bone cement. This technique achieves comparable therapeutic outcomes to curved vertebroplasty.

Accuracy of an artificial intelligence algorithm for detecting moderate-to-severe vertebral compression fractures on abdominal and thoracic computed tomography scans.

To describe the accuracy of HealthVCF, a software product that uses artificial intelligence, in the detection of incidental moderate-to-severe vertebral compression fractures (VCFs) on chest and abdominal computed tomography scans. We included a consecutive sample of 899 chest and abdominal computed tomography scans of patients 51-99 years of age. Scans were retrospectively evaluated by the software and by two specialists in musculoskeletal imaging for the presence of VCFs with vertebral body height loss > 25%. We compared the software analysis with that of a general radiologist, using the evaluation of the two specialists as the reference. The software showed a diagnostic accuracy of 89.6% (95% CI: 87.4-91.5%) for moderate-to-severe VCFs, with a sensitivity of 73.8%, a specificity of 92.7%, and a negative predictive value of 94.8%. Among the 145 positive scans detected by the software, the general radiologist failed to report the fractures in 62 (42.8%), and the algorithm detected additional fractures in 38 of those scans. The software has good accuracy for the detection of moderate-to-severe VCFs, with high specificity, and can increase the opportunistic detection rate of VCFs by radiologists who do not specialize in musculoskeletal imaging.

Assessment of a fully-parametric thoraco-lumbar spine model generator with articulated ribcage

The present paper describes a novel user-friendly fully-parametric thoraco-lumbar spine CAD model generator including the ribcage, based on 22 independent parameters (1 posterior vertebral body height per vertebra + 4 sagittal alignment parameters, namely pelvic incidence, sacral slope, L1-L5 lumbar lordosis, and T1-T12 thoracic kyphosis). Reliable third-order polynomial regression equations were implemented in Solidworks to analytically calculate 56 morphological dependent parameters and to automatically generate the spine CAD model based on primitive geometrical features. A standard spine CAD model, representing the case-study of an average healthy adult, was then created and positively assessed in terms of spinal anatomy, ribcage morphology, and sagittal profile.The immediate translation from CAD to FEM for relevant biomechanical analyses was successfully demonstrated, first, importing the CAD model into Abaqus, and then, iteratively calibrating the constitutive parameters of one lumbar and three thoracic FSUs, with particular interest on the hyperelastic material properties of the IVD, and the spinal and costo-vertebral ligaments.The credibility of the resulting lumbo-sacral and thoracic spine FEM with/without ribcage were assessed and validated throughout comparison with extensive in vitro and in vivo data both in terms of kinematics (range of motion) and dynamics (intradiscal pressure) either collected under pure bending moments and complex loading conditions (bending moments + axial compressive force).

Comparison Between Intraoperative Target Area Cement-Enhanced Percutaneous Vertebroplasty and Conventional Percutaneous Vertebroplasty for Osteoporotic Thoracolumbar Non-Total Vertebral Fractures.

To compare the efficacy and feasibility of target area cement-enhanced percutaneous vertebroplasty (PVP) and conventional PVP in osteoporotic thoracolumbar non-total vertebral fractures. Retrospective analysis of one hundred and two patients treated in our hospital from March 2020 to May 2021 and divided into groups A (targeted) and B (conventional PVP). The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height ratio, intraoperative bleeding, operative time, bone cement volume, complications, and refracture of the injured vertebra were evaluated in both groups. The 2 days and 1-year post-operative VAS and ODI scores improved significantly in both groups (p < 0.05). The 2 days post-operative VAS and ODI scores were better in group A (p < 0.05), and there was no significant difference in the scores between the groups at the last follow-up (p > 0.05). The anterior vertebral height ratios were significantly higher in both groups 2 days postoperatively (p < 0.05); however, there was no significant difference in the 2 days and 1-year post-operative ratios in group A (p > 0.05). The anterior vertebral height ratio reduced in group B after 1 year compared to the 2 days post-operative value (p < 0.05). There was no statistical difference in intraoperative bleeding and the operative time between the groups (p > 0.05), and the bone cement volume was lesser in group A (p < 0.05). Six patients in group A and four patients in group B demonstrated cement leakage, the difference was not statistically significant (p > 0.05). Three patients in group A and 11 patients in group B demonstrated refracture, the difference was statistically significant (p < 0.05). Target area cement-enhanced PVP can effectively relieve short-term pain and functional disability and reduce the long-term possibility of secondary collapse. Therefore, it is a technically feasible and efficacious method for the treatment of osteoporotic thoracolumbar non-total vertebral fractures.

Thoracolumbar Burst Fracture Treatment Using Posterior Pedicle Screw Fixation and Autogenous Bulk Iliac Bone Graft Fusion

Background: Thoracolumbar vertebral fracture is the most common type of thoracolumbar vertebral fracture. For the patients with severe thoracolumbar vertebral burst fracture and neurological impairment, surgical decompression and reconstruction of spinal stability is an important intervention method, however, there is still controversy on the way of postoperative stability reconstruction. Objective: This study was to investigate the efffcacy of posterior open reduction, pedicle screw ffxation, and autogenous iliac bone graft fusion in the treatment of thoracolumbar burst fractures with neurological impairment. Methods: The clinical data of 43 patients with thoracolumbar single vertebral burst fracture with neurological function injury treated in our department from January 2016 to December 2020 were retrospectively analyzed. The Visual Analog Scale (VAS) score of lumbothoracic pain, the occupying rate of spinal canal, the ratio of the anterior height of the injured vertebral body to the normal height, Cobb angle, and the American Spinal Injury Association (ASIA) classiffcation of neurological function were compared before and after operation. All patients completed the procedure successfully. Results: Bone graft fusion was achieved in all patients, and no screw or rod was broken. The VAS score of thoracolumbar pain, the ratio of the anterior height of the injured vertebral body to the normal height, and the Cobb angle were signiffcantly lower than those before operation at 1 and 12 months after operation (P &lt; 0.001). There was no signiffcant difference in the VAS score of thoracolumbar pain, the ratio of the anterior height of the injured vertebral body to the normal height, and the Cobb angle between 1 and 12 months after operation. The occupying rate of spinal canal 6 months after operation was lower than that before operation (12.02% ±7.35% vs. 46.98% ±9.26%), and the difference was statistically signiffcant (t = 20.066, P &lt; 0.05). There was a signiffcant difference in ASIA classiffcation of neurological function between 12 months after operation and before operation (Z = −5.372, P &lt; 0.001). The neurological function was signiffcantly improved 12 months after operation. Conclusion: Reconstruction of vertebral lamina with iliac bone graft is an effective method for the treatment of thoracolumbar burst fractures, which can reduce the loss of vertebral height and recurrent kyphosis and avoid the neurological impairment caused by secondary spinal stenosis.

Comparison of the clinical effect of unilateral transverse process extrapedicular and bilateral transpedicular percutaneous kyphoplasty for thoracolumbar osteoporotic vertebral compression fracture.

Osteoporosis vertebral compression fractures (OVCF) are common with the aging process. This study aimed to compare the effects of unilateral transverse process extrapedicular (UEPKP) and bilateral transpedicular percutaneous kyphoplasty (BTPKP) for patients with thoracolumbar OVCF. Data from 136 patients with OVCF treated with single-level PKP in our hospital between May 2019 and April 2021 were studied. Patients were grouped based on surgical procedure: there were 62 patients in the UEPKP group and 74 in the BTPKP group. All clinical and radiological data were collected from medical records. Clinical outcomes, including visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores of the lumbar spine, were evaluated preoperatively, postoperatively, and at the follow-up visit. The radiological evaluations (anterior vertebral height rate and local kyphosis angle) and complications were also collected. All patients had successfully improved after surgery. In the UEPKP group, patients showed a significantly shorter operating time and lower fluoroscopy frequency than patients in the BTPKP group (p < 0.05). However, a significantly better distribution score and cement volume were found in the BTPKP group (p < 0.05). The UEPKP group achieved a significantly better VAS score (0.6 ± 0.5 vs. 0.9 ± 0.8) and ODI (24.7 ± 3.1 vs. 27.5 ± 1.8) at the final follow-up visit than the BTPKP group (p < 0.05). The UEPKP group showed significantly worse radiological outcomes (anterior height rate and local kyphosis angle) at the 6- and 12-month follow-ups (p < 0.05). As for complications, the UEPKP group showed significantly fewer facet joint violations and intraspinal leakages (p < 0.05). UEPKP could be a safe and effective alternative procedure for patients with thoracolumbar osteoporotic vertebral compression fracture, which possesses an apparent advantage in reducing intraspinal leakage and facet joint violation over BTPKP.

The Effectiveness of Vertebral Height Restoration Based on the Vertebroplasty Procedure Used to Treat Osteoporotic Vertebral Fractures.

Whether the use of a balloon or stent in vertebroplasty for vertebral fractures, such as balloon kyphoplasty (BKP) or vertebral body stenting (VBS), actually contributes to the restoration of postoperative vertebral height is unclear. The aim of the current study was to compare the effectiveness of percutaneous vertebroplasty (PVP), BKP, and VBS in the correction of collapsed vertebrae in patients with painful vertebral fractures. The cases studied involved 34 vertebrae in 28 patients treated with PVP, 43 vertebrae in 38 patients treated with BKP, and 20 vertebrae in 20 patients treated with VBS at Izinkai Takeda General Hospital. Changes in the vertebral height and local kyphosis angle were measured based on standing lumbar radiographs before and after surgery and were compared among the treatment groups. There were no differences in changes in the height of the anterior wall, middle body, or posterior wall of the treated vertebrae among the 3 treatment groups. The same was true for changes in the local kyphosis angle. The effectiveness of vertebral height restoration depended heavily upon preoperative vertebral instability in all the treatment groups. Correction loss due to balloon deflation effect or balloon sinking was noted with VBS or BKP. BKP and VBS have the advantage of reducing the risk of extravertebral leakage of injected bone cement, but they have a disadvantage in that they are no more effective than PVP in restoring collapsed vertebrae despite the use of a balloon or metal stent.

CLINICO-RADIOLOGICAL OUTCOMES IN SHORT SEGMENT FIXATION INCLUDING FRACTURE LEVEL FOR UNSTABLE THORACOLUMBAR JUNCTION FRACTURES (T10-L2)

Background: Thoracolumbar region being a transition zone is frequently injured during trauma. Treatment aims to achieve stable fixation while preserving mobility, prevent deformity, and improve neurology. Short-segment fixation, with fracture level pedicle screw fixation, is popular for preserving motion. This study assesses the clinico-radiological outcomes for short segment fixation including fracture level for unstable thoracolumbar fractures. Methods: This was an observational study conducted at a tertiary care center from December 2020 to November 2022 after receiving ethical approval among single level burst fractures (AO type A3 &amp; A4) at the thoracolumbar junction. Patients with AO type B and C fractures, osteoporotic burst fractures, lack of surgical consent, and multi-level vertebral fractures were excluded from the study. The study utilized ASIA impairment scale, Visual Analogue Score(VAS), and radiological parameters (Kyphotic angle and Loss of vertebral body height) to assess patients immediately, postoperatively and at 6 weeks, 3 months, and 6 months follow-up. Results: Out of 20 patients,70% of the fractures were AO type A3, while the remaining 30% were type A4. The injury resulted in a 56.25 ± 13.75% loss of vertebral height. The mean kyphotic angle improved significantly from 24.38 ± 3.77 degrees preoperatively to 5.92 ± 1.91 degrees at 6 months post-operatively. The VAS scores showed significant improvement from 7.85 ± 0.67 preoperatively to 0.65 ± 0.81 at 6 months postoperatively. Conclusions: Use of pedicle screw in the fractured vertebra can result in significant improvement in post-operative pain and kyphosis correction utilizing fewer motion segment with satisfactory clinic-radiological outcome.

Treatment for Osteoporotic Vertebral Fracture - A Short Review of Orthosis and Percutaneous Vertebroplasty and Balloon Kyphoplasty.

The management of osteoporotic vertebral fractures (OVFs) in the elderly includes nonoperative treatment and vertebroplasty, but has not been established due to the diversity of patient backgrounds. The purpose of this study was to compare the impact of 3 treatment modalities for the management of OVF: orthotic treatment, percutaneous vertebroplasty (PVP), and balloon kyphoplasty (BKP). The method was based on an analysis of the latest RCTs, meta-analyses, and systematic reviews on these topics. No study showed a benefit of bracing with high level of evidence. Trials were found that showed comparable outcomes without orthotic treatment. Only 1 randomized controlled trial (RCT) showed an improvement in pain relief up to 6 months compared with no orthosis. Rigid and nonrigid orthoses were equally effective. Four of 5 RCTs comparing vertebroplasty and sham surgery were equally effective, and one RCT showed superior pain relief with vertebroplasty within 3 weeks of onset. In open trials comparing vertebroplasty with nonoperative management, vertebroplasty was superior. PVP and BKP were comparable in terms of pain relief, improvement in quality of life, and adjacent vertebral fractures. BKP does not affect global sagittal alignment, although BKP may restore vertebral body height. An RCT was published showing that PVP was effective in chronic cases without pain relief. Vertebroplasty improved life expectancy by 22% at 10 years. The superiority of orthotic therapy for OVF was seen only in short-term pain relief. Soft orthoses proved to be a viable alternative to rigid orthoses. Vertebroplasty within 3 weeks may be useful. There is no significant difference in clinical efficacy between PVP and BKP. Vertebroplasty improves life expectancy.

Trends in Vertebral Augmentation Practice for Osteoporotic Vertebral Fracture

Osteoporosis is characterized by low bone mass, primarily affecting older individuals and a common complication is vertebral fractures. The collapse-induced height loss in vertebrae can result in spinal instability and progressive kyphotic deformity. Surgical intervention for osteoporotic vertebrae poses challenges due to poor bone quality and frequent medical comorbidities. In recent years, it has become the predominant method for vertebral augmentation in acute fractures, aiming to relieve pain, strengthen the vertebral structure, and prevent deformities by restoring height. These procedures involve percutaneous placement of cannulas into each collapsed vertebral body through a unipedicular or bipedicular approach.&#x0D; Novel products are emerging to strengthen vertebrae in treating osteoporotic compression fractures. Balloon kyphoplasty and vertebroplasty are widely accepted and recognized as effective vertebral augmentation methods. Treatment guidelines are evolving with the introduction of innovative systems like Vertebral Body Stenting, Titanium Mesh, and Sky Bone Expander, claiming to achieve exceptional vertebral height restoration. Controversies persist regarding the optimal timing for vertebral augmentation post-fracture.&#x0D; Polymethylmethacrylate cement is extensively used to stabilize fractured vertebral bodies. Additionally, new calcium phosphate-based nanocomposite cements are gaining prominence. These advancements underscore the ongoing development in the treatment of osteoporotic vertebral compression fractures. Each innovative implant introduces unique features and indications. Precise confirmation of the source of the painful fracture is crucial for effective and safe treatment, ensuring proper timing and indication.

Radiological and anatomical evaluation of the cervical spinal cord, spinal canal, and intervertebral disc morphometry in healthy adults

Purpose: The aim of this study was to examine the normal values of the cervical spinal cord, spinal canal, and intervertebral disc morphometry of healthy subjects in this study &#x0D; Materials and Methods: Cervical magnetic resonance imaging of 83 healthy subjects were examined retrospectively. The anterior and posterior height of each cervical vertebra body, anterior and posterior height of each intervertebral disc between C3-T1, and spinal canal and cord diameters were measured. Additionally, the height ratios of the cervical vertebra body and intervertebral disc were calculated.&#x0D; Results: There was no significant difference between genders in spinal cord diameters from C1 to C7, whereas there was a significant difference between genders in spinal canal diameters from C1 to C4. There were significant differences between genders in terms of anterior and posterior vertebral body height from C3 to C7 level. Moreover, significant differences between genders in terms of anterior and posterior intervertebral height from C3-4 to C7-T1 level (except C6-7 intervertebral anterior height) were found. &#x0D; Conclusion: We would like to stress that the cervical region is a clinically important structure because of its location, surgical importance, its exposure to a large number of injuries, Gender plays the most important role in spinal canal morphometry, following vertebral

Morphometric study of the lumbar vertebrae in dried anatomical collections

Background The objective of this anatomical study was to perform the morphometry of dried lumbar vertebrae in human cadavers. Methods This study utilized 200 adult human cadaveric dried lumbar vertebrae. The digital Vernier calipers was used to perform the measurements. The height, antero-posterior length, transverse length of the body of the vertebrae, interpedicular distance at the lateral ends, lamina length, height and thickness, superior and inferior articular facet height and width, mid sagittal and transverse diameter of vertebral foramen, height, width and thickness of the pars inter-articularis were measured. Results The vertebral body’s anteroposterior length was more at the lower border than at the superior border (p &lt; 0.01). The length of lamina was higher over the right in comparison to the left (p &lt; 0.001). The height of lamina, width of inferior articular facet, diameter of lateral recess and thickness of pars inter-articularis were greater for the left sided specimens (p &lt; 0.01). The statistical significance was not observed for the comparison of the remaining parameters (p &gt; 0.05). Conclusion This anatomical study offered several dimensions of lumbar vertebrae, which are essential in the surgical practice. The implants at the lumbar vertebrae need to be manufactured based on the anatomical dimensions of that particular sample population.

Factors influencing vertebral collapse in osteoporotic vertebral fractures: a case-control study of symptomatic patients attended in the emergency department.

To identify risk factors for collapse of osteoporotic vertebral fractures (OVF) on computed tomography (CT) and conventional radiography (CR). This is a retrospective case-control study including a series of patients with OVF diagnosed at the emergency department of our institution from January to September 2019. Inclusion criteria were to have standing CR and supine CT within 2weeks after the diagnosis of OVF and a follow-up CR at 6months or later. We evaluated different imaging measurements at the initial diagnostic examinations, including vertebral height loss, local kyphosis, vertebral density, and fracture type according to the grading systems of Genant, Sugita, Association of Osteosynthesis (AO) Spine, and the German Society for Orthopaedics and Trauma. Vertebral collapse was defined as loss of ≥ 50% of vertebral area or height. Cases and controls were defined as OVFs which collapse and do not collapse, respectively, on follow-up. Fifty-six patients were included in the study, with a mean age of 72.6 ± 1.2years, including 48 women. Twenty-five (44.6%) OVFs developed collapse on follow-up. None of the fracture classification systems were found to be predictive of collapse. Multivariate analysis showed that older age, increased density ratio (≥ 2) between the fractured and non-fractured vertebral bodies, and a ≥ 6% difference in posterior vertebral height (PVH) loss between standing CR and supine CT exhibited 88% discriminative power in predicting vertebral collapse. Age over 72.5years, a density ratio ≥ 2 between the fractured and non-fractured vertebral bodies, and a difference equal to or higher than 6% in PVH loss between standing CR and supine CT, are risk factors for developing vertebral collapse after OVF.

Establishing a nomogram to predict refracture after percutaneous kyphoplasty by logistic regression.

Several studies have examined the risk factors for post-percutaneous kyphoplasty (PKP) refractures and developed many clinical prognostic models. However, no prior research exists using the Random Forest (RF) model, a favored tool for model development, to predict the occurrence of new vertebral compression fractures (NVCFs). Therefore, this study aimed to investigate the risk factors for the occurrence of post-PKP fractures, compare the predictive performance of logistic regression and RF models in forecasting post-PKP fractures, and visualize the logistic regression model. We collected clinical data from 349 patients who underwent PKP treatment at our institution from January 2018 to December 2021. Lasso regression was employed to select risk factors associated with the occurrence of NVCFs. Subsequently, logistic regression and RF models were established, and their predictive capabilities were compared. Finally, a nomogram was created. The variables selected using Lasso regression, including bone density, cement distribution, vertebral fracture location, preoperative vertebral height, and vertebral height restoration rate, were included in both the logistic regression and RF models. The area under the curves of the logistic regression and RF models were 0.868 and 0.786, respectively, in the training set and 0.786 and 0.599, respectively, in the validation set. Furthermore, the calibration curve of the logistic regression model also outperformed that of the RF model. The logistic regression model provided better predictive capabilities for identifying patients at risk for post-PKP vertebral fractures than the RF model.

Clinical efficacy of percutaneous vertebroplasty versus percutaneous kyphoplasty treating osteoporotic vertebral compression fractures with kyphosis.

This study aimed to investigate the clinical efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral compression fractures (OVCFs) with kyphosis. The clinical data included 63 patients in the PVP group and 70 in the PKP group. The study assessed the pain visual analog scale (VAS), Oswestry Disability Index (ODI), wedge angle (WA), local kyphotic angle (LKA), and vertebral height. The operative time was significantly less in the PVP group (p < 0.05). Meanwhile, more bone cement was injected into the PKP group (p < 0.05), with significantly higher surgical costs (p > 0.05). Post-operative VAS, ODI, WA, LKA, and vertebral height were significantly improved in PVP and PKP groups compared with pre-operative measurements (p < 0.05). The results revealed insignificant VAS and ODI improvement differences between the two groups at each follow-up time (p > 0.05). Vertebral height, WA, and LKA improved more significantly in the PKP group at day 1 and 3months post-operatively (p < 0.05), with insignificant group differences at subsequent time points (p > 0.05). The improvements in VAS were unrelated to those in WA, LKA, or vertebral height in either group (p > 0.05). The improvement in VAS was unrelated to the amount of bone cement injected (p > 0.05); the PKP group demonstrated a lower incidence of cement leakage (12.9%; p < 0.05). PVP and PKP can restore partial vertebral height and improve kyphosis with similar clinical outcomes. PVP has a shorter operating time, is more economical, and can represent a therapeutic choice.