Vertebral Research Articles

Artificial intelligence image analysis for Hounsfield units in preoperative thoracolumbar CT scans: an automated screening for osteoporosis in patients undergoing spine surgery.

This study aimed to develop an artificial intelligence (AI) model for automatically detecting Hounsfield unit (HU) values at the L1 vertebra in preoperative thoracolumbar CT scans. This model serves as a screening tool for osteoporosis in patients undergoing spine surgery, offering an alternative to traditional bone mineral density measurement methods like dual-energy x-ray absorptiometry. The authors utilized two CT scan datasets, comprising 501 images, which were split into training, validation, and test subsets. The nnU-Net framework was used for segmentation, followed by an algorithm to calculate HU values from the L1 vertebra. The model's performance was validated against manual HU calculations by expert raters on 56 CT scans. Statistical measures included the Dice coefficient, Pearson correlation coefficient, intraclass correlation coefficient (ICC), and Bland-Altman plots to assess the agreement between AI and human-derived HU measurements. The AI model achieved a high Dice coefficient of 0.91 for vertebral segmentation. The Pearson correlation coefficient between AI-derived HU and human-derived HU values was 0.96, indicating strong agreement. ICC values for interrater reliability were 0.95 and 0.94 for raters 1 and 2, respectively. The mean difference between AI and human HU values was 7.0 HU, with limits of agreement ranging from -21.1 to 35.2 HU. A paired t-test showed no significant difference between AI and human measurements (p = 0.21). The AI model demonstrated strong agreement with human experts in measuring HU values, validating its potential as a reliable tool for automated osteoporosis screening in spine surgery patients. This approach can enhance preoperative risk assessment and perioperative bone health optimization. Future research should focus on external validation and inclusion of diverse patient demographics to ensure broader applicability.

A pre-clinical evaluation of geometrical stitching errors in a cone beam system: possible implications for weight-bearing CT imaging of the spine.

BackgroundTotal body cone-beam computed tomography (CBCT) is recently developed for both weight-bearing and non-weight-bearing CT imaging of the spine. Before whole-spine weight-bearing CT is used in clinical practice, potential errors must be addressed, such as the need to stitch multiple volumes due to the field-of-view limitations of CBCT technology.PurposeTo determine the geometric error of fused CBCT images of the spine using automatic stitching software.Material and MethodsIn total, 144 CBCT scans were obtained using three human cadavers. The geometric stitching error was determined in terms of total translation and rotation between vertebrae Th12 and L5, which were positioned in separate image volumes, with a regular spiral CT scan as a reference. The effect of cadaver size, radiation dose, and volume overlap between adjacent CBCT images on the stitching error was determined using Spearman's rank correlation test.ResultsThe median total translation and rotation error were 1.88 mm (interquartile range [IQR] = 1.48-2.42 mm) and 0.54° (IQR = 0.35°-0.63°), respectively. A weak negative correlation between the different volumes of overlap and total translation (r = -0.396; P < 0.001) and rotation (r = -0.319; P < 0.001) was found, as well as a weak positive correlation between the cadaver size and total translation (r = 0.456; P < 0.001).ConclusionThe results of this cadaver study showed stitching errors in the order of 2 mm for translation and 0.5° for rotation in fused CBCT volumes of the spine. These findings function as a relevant step towards the clinical and quantitative application of whole-spine weight-bearing CT imaging.

Sarcopenia Abdominal Muscle Mass Index Assessment Informs Surgical Decision-Making in Displaced Fractures of the Femoral Neck

Background: Displaced femoral neck fractures (FNFs) can be treated with hemiarthroplasty (HA) or total hip arthroplasty (THA), with THA typically offered to fitter patients. Sarcopenia increases complications and mortality after hip arthroplasty. The psoas muscle–L3 vertebra ratio (PML3) is a sarcopenia marker. This study evaluated PML3’s role in predicting postoperative outcomes and guiding surgical decision-making. Methods: A retrospective study was conducted at a single centre between January 2021 and December 2024. PML3 was measured on computed tomography (CT) at the L3 vertebra level for patients with displaced FNFs, comparing postoperative outcomes between HA and THA cohorts. Results: Eighty-three patients (fifty-seven female, twenty-six male) were analysed. Forty-three underwent THA, and forty underwent HA. Postoperative complications were higher in HA patients (48% vs. 21%, p = 0.019), with lower 30-day survival (90% vs. 98%). Median PML3 in the HA group was 0.70 mm2 (IQR: 0.47–1.47), lower than in the THA group (1.34 mm2, IQR: 1.00–1.78, p = 0.002). However, PML3 values for patients that suffered complications (irrespective of surgical decision) were essentially the same; HA, 0.57 mm2 (IQR: 0.43–1.83); THA 0.56 mm2 (IQR: 0.41–1.05, p = 0.847). ROC analysis showed PML3 as an acceptable predictor of postoperative complications, with an AUC of 0.71. Conclusions: Lower PML3 values correlate with higher postoperative complications and mortality following THA or HA for displaced FNFs, confirming its role as a prognostic marker. Some THA complications in low-PML3 patients might have been avoided by selecting less invasive HA, suggesting THA should be reserved for those with greater muscle reserves.

U-Net-Based Deep Learning Hybrid Model: Research and Evaluation for Precise Prediction of Spinal Bone Density on Abdominal Radiographs

Osteoporosis is a metabolic bone disorder characterized by the progressive loss of bone mass, which significantly increases the risk of fractures. While dual-energy X-ray absorptiometry is the standard technique for assessing bone mineral density, its use is limited in high-risk female populations. Additionally, quantitative computed tomography offers three-dimensional evaluations of bone mineral density but is costly and prone to motion artifacts. To overcome these limitations, this study proposes a hybrid model integrating U-Net and artificial neural networks, specifically focusing on abdominal X-ray images in the anteroposterior view for detailed skeletal analysis and improved accuracy in L2 vertebra mineral density measurement. The model targets female patients, who are at a higher risk for spinal disorders and osteoporosis. The U-Net model is employed for image preprocessing to reduce background noise and enhance bone tissue features, followed by analysis with the artificial neural network model to predict bone mineral density through nonlinear regression. The performance of the model, demonstrated by a high correlation coefficient of 0.77 and a low mean absolute error of 0.08 g per square centimeter, highlights its significance and effectiveness, particularly in comparison to dual-energy X-ray absorptiometry.

Prognostic value of sarcopenia in patients with unresectable colorectal liver metastases after drug-eluting beads transcatheter arterial chemoembolization: a single center retrospective study

Sarcopenia is a prevalent condition in tumor patients and can potentially impact the prognosis of tumor treatment. This retrospective study aimed to evaluate the correlations between sarcopenia and the prognosis of patients with unresectable colorectal liver metastases (CRLM) received drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) therapy. From December 2018 to December 2023, unresectable CRLM patients who had already received second-line therapy from the Wuhan Union Hospital were involved in our study. Skeletal muscle mass was evaluated on CT at the L3 vertebra, and the optimal cut-off point for skeletal muscle index classification was determined using x-tile software. Overall survival (OS) and progression-free survival (PFS) were estimated using Kaplan–Meier analysis and Cox regression analysis. Seventy-one patients were included in the study, 34 with sarcopenia (sarcopenia group) and 37 without sarcopenia (non-sarcopenia group), respectively. The median PFS and OS was elevated in the non-sarcopenia group compared with the sarcopenia group (6.1 months versus 4.3 months, p = 0.012; 14.8 months versus 10.2 months, p < 0.001). The multivariate Cox regression analysis revealed that sarcopenia, extrahepatic metastases, and neutrophil-to-lymphocyte ratio (NLR) ≥ 5 were identified as independent risk factors for both PFS and OS. The advantages of non-sarcopenia in terms of OS were consistent across all subgroups examined. Additionally, the sarcopenia group exhibited a higher incidence of vomiting/nausea, fatigue, and abdominal pain following the DEB-TACE operation compared to the non-sarcopenia group. Sarcopenia demonstrated a substantial predictive value for both PFS and OS in unresectable CRLM patients who underwent DEB-TACE treatments. Besides, NLR > 5 and extrahepatic metastases were independent risk factors linked to a poorer prognosis. Furthermore, patients with sarcopenia may face an increased likelihood of experiencing adverse events following DEB-TACE treatments.

Evaluation of lumbar vertebral bone quality using T1-weighted MRI: Can it differentiate normal, osteopenia, and osteoporosis?

Evaluation of lumbar vertebral bone quality using T1-weighted MRI: Can it differentiate normal, osteopenia, and osteoporosis?

Severe old lumbar fracture and dislocation with cauda equina nerve transection: A case report.

Severe old lumbar fractures and dislocations with associated cauda equina nerve transection are rare clinical presentations which pose significant management challenges. This case report highlights a unique instance of such an injury, emphasizing novel surgical strategies for reconstruction and recovery. A 30-year-old male patient was admitted after sustaining a severe open fracture and degree IV posterior dislocation of L3 vertebra, accompanied by cauda equina nerve transection, spinal cord injury and multiple organ injuries. Following initial stabilization, the patient underwent surgical reduction and internal fixation two months after the injury. The procedure involved cauda equina nerve reconstruction using sural nerve grafts. Postoperatively, the patient showed improved bladder function and regained some mobility. However, he later developed arachnoiditis ossificans of the cauda equina, resulting in severe pain, which required additional surgical intervention. In conclusion, this case underscores the importance of timely intervention in severe thoracolumbar injuries and presents a successful approach to nerve reconstruction.

17 Optimizing trauma prognostication via machine learning: Automating frailty detection in geriatric trauma patients

Objectives/Goals: This study evaluates the role of visual machine learning algorithms (VMLA) in automating a predictive model of central sarcopenia in geriatric trauma patients based on the psoas:lumbar vertebral index (PLVI) and trauma-specific frailty index (TSFI). Methods/Study Population: 150 trauma patients seen at Jon Michael Moore Trauma Center within J.W Ruby Memorial Hospital in rural West Virginia were included in this investigation across the life spectrum. The VMLA was trained on their standard of care trauma panoramic CT scans. Five expert reviewers segmented bilateral psoas muscles and the L4 vertebrae of each CT image at one slice inferior to the posterior elements of the L4 vertebrae. The data were read into a U-net convoluted neural network as ground truth. Labels were preprocessed to focus on the regions of interest and standardized into four classes: right psoas, left psoas, L4 vertebrae, and background. Performance was evaluated using accuracy, Dice coefficient, and F1 score. Results/Anticipated Results: Between our expert reviewer segmentations, we had significant inter-reader reliability with a Kappa greater than 0.8 and a mean standard deviation of the PLVI of 0.10mm^2. Preliminary VMLA testing on a subset of 70 patients yielded a validation accuracy of 88.5%, a Dice coefficient of 0.86, and an F1 score of 0.87 after 20 epochs. There was a moderate interclass correlation between PLVI and TSFI even though the TSFI lacks sensitivity. In fact, the PLVI is a more accurate predictor of frailty in trauma patients based on various outcome measures such as corrected length of stay. Our ongoing efforts are centered around improving the VMLA. Discussion/Significance of Impact: Our VMLA outperforms the current clinical standard, TSFI. Integration of our VMLA into the clinical workflow has the potential to revolutionize geriatric trauma care by providing rapid, accurate, identification of high-risk frail patients.

37-Day microgravity exposure in 16-Week female C57BL/6J mice is associated with bone loss specific to weight-bearing skeletal sites

Exposure to weightlessness in microgravity and elevated space radiation are associated with rapid bone loss in mammals, but questions remain about their mechanisms of action and relative importance. In this study, we tested the hypothesis that bone loss during spaceflight in Low Earth Orbit is primarily associated with site-specific microgravity unloading of weight-bearing sites in the skeleton. Microcomputed tomography and histological analyses of bones from mice space flown on ISS for 37 days in the NASA Rodent Research-1 experiment show significant site-specific cancellous and cortical bone loss occurring in the femur, but not in L2 vertebrae. The lack of bone degenerative effects in the spine in combination with same-animal paired losses in the femur suggests that space radiation levels in Low Earth Orbit or other systemic stresses are not likely to significantly contribute to the observed bone loss. Remarkably, spaceflight is also associated with accelerated progression of femoral head endochondral ossification. This suggests the microgravity environment promotes premature progression of secondary ossification during late stages of skeletal maturation at 21 weeks. Furthermore, mice housed in the NASA ISS Rodent Habitat during 1g ground controls maintained or gained bone relative to mice housed in standard vivarium cages that showed significant bone mass declines. These findings suggest that housing in the Rodent Habitat with greater topological enrichment from 3D wire-mesh surfaces may promote increased mechanical loading of weight-bearing bones and maintenance of bone mass. In summary, our results indicate that in female mice approaching skeletal maturity, mechanical unloading of weight-bearing sites is the major cause of bone loss in microgravity, while sites loaded predominantly by muscle activity, such as the spine, appear unaffected. Additionally, we identified early-onset of femoral head epiphyseal plate secondary ossification as a novel spaceflight skeletal unloading effect that may lead to premature long bone growth arrest in microgravity.

Trabecular texture and paraspinal muscle characteristics for prediction of first vertebral fracture: a QCT analysis from the AGES cohort.

Vertebral fractures (VFs) significantly increase risk of subsequent fractures. Areal bone mineral density (BMD) assessed by DXA and volumetric BMD by QCT, are strong predictors of VF. Nevertheless, risk prediction should be further improved. This study used data from the Age, Gene/Environment Susceptibility Reykjavik (AGES-Reykjavik) cohort to evaluate whether trabecular texture and paraspinal muscle assessments improve the prediction of the first incident VF. CT scans of the L1 and L2 vertebrae of 843 elderly subjects; including 167 subjects with incident, VFs occurring within a 5-year period and 676 controls without fractures. Image analysis included measurement of BMD, cortical thickness and of parameters characterizing trabecular architecture and the autochthonous muscles. Fifty variables were used as predictors, including a BMD, a trabecular texture and a muscle subset. Each included age, BMI and corresponding parameters of the QCT analysis. The number of variables in each subset was reduced using stepwise logistic regression to create multivariable fracture prediction models. Model accuracy was assessed using the likelihood ratio test (LRT) and the area under the curve (AUC) criteria. Bootstrap analyses were performed to assess the stability of the model selection process. 96 women and 78 men with prior VF were excluded. Of 50 initial predictors, 17 were significant for women and 11 for men. Bone and texture models showed significantly better fracture prediction in women (p<0.001) and men (p<0.01) than the combination of age and BMI. The muscle model showed better fracture prediction in men only (p<0.03). Compared to the BMD model alone, LRT showed a significantly improved VF prediction of the combinations of BMD with texture (women and men) (p<0.05) or with muscle models (men only) (p=0.03) but no significant increases in AUC values (AUC women: Age&BMI: 0.57, BMD: 0.69, combined model: 0.69; AUC men: Age&BMI: 0.63, BMD: 0.71, combined models 0.73-0.77). Trabecular texture and muscle parameters significantly improved prediction of first VF over age and BMI, but improvements were small compared to BMD, which remained the primary predictor for both sexes. Although muscle measures showed some predictive power, particularly in men, their clinical significance was marginal. Integral BMD should remain the focus for fracture risk assessment in clinical practice.

Preoperative CT attenuation value classification assesses cage subsidence risk in 112 OLIF surgery cases

Retrospective Study. This study investigates the effectiveness of preoperative vertebral computed tomography (CT) attenuation value classification in predicting cage subsidence in Oblique lumbar interbody fusion (OLIF) surgeries. This study aims to evaluate the feasibility of using CT attenuation value classification to predict cage subsidence. A retrospective analysis of L4-5 OLIF surgeries from May 2019 to June 2022, with over one year of follow-ups, was performed. Patients were classified into subsidence and non-subsidence groups based on postoperative outcomes. Demographic and perioperative variables, preoperative CT attenuation values, and changes in Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores were compared. Of 112 patients (29 in the subsidence group, 83 in the non-subsidence group), significant differences in gender (P = 0.032) and DXA T-value (P = 0.010) were noted, with the subsidence group predominantly female. The consistency of CT attenuation values across L1-L5 vertebral bodies demonstrated strong reliability, with intraclass correlation coefficient (ICC) ranging from 0.76 to 0.91. CT attenuation values, categorized into osteoporosis, osteopenia, and regular bone mass groups, correlated significantly with bone density and subsidence, especially at the L1 vertebra (r = 0.548, P < 0.001). Multivariate logistic regression confirmed the predictive value of vertebral CT stratification, with L1-L5 Odds Ratios (OR) ranging from 0.07 to 0.26. Females are more prone to OLIF-related cage subsidence. The measurement of CT attenuation values demonstrated strong reliability and consistency. Preoperative vertebral CT attenuation value classification correlates with bone density and subsidence risk, particularly at the L1 vertebra, and strongly predicts cage subsidence.

Effect of electroacupuncture regulating BDNF/NRF2 signaling pathway on oxidative stress in dorsal root ganglion of rabbits with lumbar intervertebral disc degeneration

To observe the protective function and mechanism of electroacupuncture (EA) "Jiaji" (EX-B2) on dorsal root ganglion (DRG) in rabbits with pressure-induced lumbar intervertebral disc degeneration (IVDD). Twenty-five male New Zealand rabbits with mature bones were divided into control, sham operation, model, EA, and acupuncture groups, with 5 rabbits in each group. The IVDD model was established by inserting kirschner wires to the vertebral bone surface between the lumbar (L) 4 and L5 vertebrae, followed by applying continuous axial pressure for 28 days. EA (2 Hz/15 Hz, 1 mA) or acupuncture (only insertion of acupuncture needles into bilateral EX-B2, but without electrical stimulation) was applied to bilateral EX-B2 for 20 min, once daily for 28 days. The general conditions and weight changes of rabbits in each group were observed, and the free walking pain score was calculated after interventions. The morphology and structure of DRG cells were observed by HE staining. The activities of superoxide dismutase (SOD), glycine peroxidase (GSH-Px) catalase (CAT) and content of malondialdehyde (MDA) in DRG were detected by ELISA. The concentration of calcium ions in DRG was measured by flow cytometry. The protein expression levels of brain-derived neurotrophic factor (BDNF), nuclear factor E2 related factor 2 (NRF2), heme oxygenase-1 (HO-1) and NAD (P) quinone oxidoreductase 1 (NQO1) in DRG were detected by Western blot. Compared with the sham operation group, the free walking pain score of rabbifs in the model group was significantly increased (P<0.01), and the concentration of calcium ion and content of MDA in DRG were significantly increased (P<0.01), the contents of SOD, GSH-PX and CAT and the protein expressions of BDNF, NRF2, NQO1 and HO-1 in DRG were significantly decreased (P<0.01). Compared with the model group, the free walking pain score of rabbits in the EA group was significantly decreased (P<0.01), the concentration of calcium ions and the content of MDA in DRG were decreased (P<0.01), the contents of SOD, GSH-PX and CAT and the protein expressions of BDNF, NRF2, NQO1 and HO-1 were significantly increased (P<0.01). The effect of EA was better than acupuncture (P<0.01, P<0.05). HE staining showed atrophied cell bodies, disordered cellular arrangement, dissolved nuclei, and indistinct borders of DRG cells in the model group, which was milder in both acupuncture and EA groups. EA at EX-B2 may inhibit oxidative stress in DRG cells by regulating BDNF/NRF2 signaling pathway, protect DRG cell damage, reduce nerve pain, thus delay the progression of IVDD.

Optimal lumbar vertebral level for trunk muscle CT assessments in opportunistic sarcopenia screening: a cross-sectional study

ObjectivesThis study aims to identify the optimal lumbar vertebral level for CT-based assessments of trunk muscles in relation to physical function and muscle strength, and to establish a foundation for...

The Relationship Between the Heterogeneity of Lumbar Vertebral Trabecular Bone Mineral Density Distribution and Osteoporotic Vertebral Fractures.

This study aims to investigate the relationship between the spatial distribution and heterogeneity of lumbar vertebral trabecular volumetric bone mineral density (vBMD) and osteoporotic vertebral fractures(OVF). This retrospective study included the L1 and L2 vertebrae of 143 participants with osteoporotic vertebral fractures and 429 age- and sex-matched no-fractured controls. Spatial distribution was assessed using the superior/middle and inferior/middle ratios, while heterogeneity was indicated by the quartile coefficient of variation (QCV) and interquartile range (IQR). We used QCT to measure the integral vBMD of the vertebra and the regional vBMD in the superior, middle, and inferior subregions. QCV and IQR were computed for both integral vertebrae and three subregions using voxel values from CT images. Differences between fracture and control groups were analyzed after stratification by age and sex. T-tests and Wilcoxon rank-sum tests assessed differences in spatial distribution and heterogeneity between fracture and control groups. Conditional logistic regression was employed to evaluate the associations between spatial distribution and heterogeneity with osteoporotic vertebral fractures. Trabecular vBMD was higher in the middle subregion of the vertebrae than the superior and inferior subregions. The fracture group had lower mean integral vBMD than controls. In terms of the spatial distribution, significant differences in the superior/middle and inferior/middle ratios of the L1 vertebra were observed between the fracture and control groups in the female 40-60years group. The superior/middle ratio of the L1 vertebra in males was positively correlated with the fracture risk. Regarding heterogeneity, the fracture group had a higher QCV than the control group. QCV was positively correlated with fracture risk, with no significant variation between sexes. The spatial distribution and heterogeneity of trabecular vBMD are crucial for predicting vertebral fracture risk. These indicators are essential for fracture risk assessment and may inform prevention and treatment strategies.

SAPHO syndrome with bone destruction in the lumbar vertebral endplates: a case report.

SAPHO syndrome is a rare inflammatory osteoarticular disorder, which includes autoimmune diseases such as pustulotic arthro-osteitis, inflammatory bowel disease-associated spondyloarthritis, and psoriatic arthritis. There are few reports on the treatment of SAPHO syndrome that presents with bone destruction in the spine. We present a case in which adalimumab (ADA) was administered to treat destruction of the lumbar vertebral endplates caused by SAPHO syndrome. The patient was a woman in her 20s who was referred to our hospital with complaints of low back pain; acne on the face, anterior chest, and back; and sternoclavicular joint pain. Blood tests showed a mild increase in C-reactive protein but negative results for rheumatoid factor and anti-cyclic citrullinated peptide antibody. Radiographs and computed tomography (CT) images demonstrated destruction with surrounding bone sclerosis in the cranial endplates of the L4 and L5 vertebrae and the left sternoclavicular joint. The Ankylosing Spondylitis Disease Activity Score (ASDAS) was 2.05, and the Bath Ankylosing Spondylitis Functional Index (BASFI) was 3.00. Despite the use of the maximum dose of non-steroidal anti-inflammatory drugs, her symptoms did not improve, and ADA was administered at a dose of 40 mg every two weeks. After ADA administration, both the ASDAS and BASFI were immediately reduced and low disease activity or remission was maintained thereafter. After three years, the CT images showed no progression of bone destruction in the lumbar vertebrae and sternoclavicular joint, and the patient was completely free from low back pain and was able to run normally.

Quantitative assessment of abdominal ectopic fat deposits in patients with different glucose tolerance by using mDixon Quant MRI

This study aimed to quantitatively analyze the characteristics of abdominal ectopic fat deposition in patients with different glucose tolerance by using mDixon Quant MRI. A total of 98 patients and 38 healthy volunteers were included in this study. The patients were stratified as impaired glucose tolerance (IGT) group (n = 18), the duration of diabetes less than 5 years (DMa group, n = 31) and longer than 5 years(DMb group, n = 49). The fat fraction (FF) of left hepatic lobe, right hepatic lobe, whole liver, pancreatic head, pancreatic body, pancreatic tail, spleen, kidney, as well as L3 vertebra, psoas muscle, the total abdominal fat area(S1), intra-abdominal fat area (S2) and S3 (S2/S1) were measured and calculated separately. Analysis of variance, correlation analysis, paired sample t-test, Welch’s ANOVA, ROC curve and ordered multivariate logistic regression were performed for statistical analyses. The difference in BMI and weight among the four groups were statistically significant (P < 0.001). The metabolic parameters were statistically significant among three patients groups (P < 0.05). The differences in FF values of left hepatic lobe, right hepatic lobe and whole liver, spleen, pancreatic head, pancreatic body and pancreatic tail, L3 vertebra, psoas muscle, S1, S2 and S3 were statistically significant among the four groups (P < 0.001). The FF values of L3 vertebra and the pancreatic tail had the higher diagnostic efficacy when assessing the presence and extent of impaired glucose tolerance, respectively. For each percentile increased in the FF value of the L3 vertebra, the risk of diabetes entering the next stage increases 16%. Different organs in the abdomen have different sensitivity to fat deposition. The liver and pancreas have uneven distribution of fat deposits in people with different glucose tolerance. However, ectopic fat deposition do not change significantly with the duration of the disease. The FF value of L3 vertebra is a sensitive imaging index in patients with different glucose tolerance.

The association of sarcopenia and frailty in diabetes-related foot disease: A 3-year prospective evaluation.

To prospectively evaluate the association of various markers of sarcopenia and frailty with clinical outcomes in diabetes-related foot disease (DRFD), namely wound healing, amputation-free survival, and death over 3years. This was an observational study of patients with DRFD at a quaternary multidisciplinary diabetic foot service. Initial assessment includes classification of DRFDs using WIfI classification, assessment of frailty using the FRAIL scale, and measurement of handgrip strength (HGS) using a dynamometer. Muscle mass was ascertained by measuring the psoas muscle area at the level of L3 vertebrae on computed tomography. Patients were followed up for 3years and primary outcomes were wound healing, amputation-free survival, and death. One hundred patients with a median age of 71 were included in the analysis. The majority of the patients were male (75%). Forty-seven percent of patients were considered as frail, with 37 patients recorded to have low HGS. Patients with high HGS had significantly higher odds of wound healing by 3.83 times when compared to those with low HGS (odds ratio=3.83. 95% CI 1.35-10.92). Patients with low psoas muscle index (PMI) and low HGS were observed to have a higher risk of death based on the following hazard ratios: HGS (high vs. low), HR=0.46, 95% CI: 0.22-0.997; PMI (low vs. high), HR=2.15, 95% CI: 1.17-3.96. There was a significant prevalence of frailty and reduced HGS among our patients with DRFD. Low HGS was associated with poor wound healing and increased mortality in patients with DRFD. Additionally, low muscle mass was associated with increased mortality in this population. This research highlights the need for more precise tests and future studies of the links between sarcopenia, frailty, and outcomes in DRFD.

A data-driven framework for developing a unified density-modulus relationship for the human lumbar vertebral body.

A data-driven framework for developing a unified density-modulus relationship for the human lumbar vertebral body.

Treatment Goals for Prevention of Vertebral Fractures in Patients with Rheumatoid Arthritis.

Patients with rheumatoid arthritis (RA) are at an increased risk of osteoporosis and vertebral fractures. This study aimed to investigate factors associated with vertebral fractures and treatment goals to prevent new vertebral fractures in patients with RA. The database used in this study included outpatient data of RA patients at the authors' hospital of RA patients taken from 2018 to 2022. The patients underwent annual imaging evaluations to assess parameters, including bone mineral density of the lumbar spine (LS; L2-4), total hip, and femoral neck, as well as vertebral fractures. Vertebral fractures were evaluated using radiographic images of the T8 to L5 vertebrae. The prevalence rates of new vertebral fractures in 2018-2019, 2019-2020, 2020- 2021, and 2021-2022 were 2.0%, 1.3%, 2.3%, and 2.0%, respectively. The presence of existing vertebral fractures was associated with new vertebral fractures (p=0.003; odds ratio, 0.241; 95% confidence interval, 0.093-0.624). The cut-off T-score values for the LS for new vertebral fractures in patients with or without pre-existing vertebral fractures were -0.7 (sensitivity, 40.9%; specificity, 100%) and -1.4 (sensitivity, 69.0%; specificity, 62.5%), respectively. The presence of pre-existing vertebral fractures is an independent factor associated with new vertebral fractures. It is important to tailor treatment goals based on the presence or absence of vertebral fractures to effectively prevent new fractures.

Multiscale dynamics analysis of lumbar vertebral cortical bone based on the Abaqus submodel finite element method

The direct effect of macroscopic loads on the microstructure of bone tissue in a vibration environment is not yet known. Therefore, this study aims to investigate the macro- and micro-biomechanical properties of the lumbar spine system under dynamic loading in such an environment. We analyzed the dynamic characteristics of osteon by establishing a macro- and micro-scale model of the lumbar spine, using a submodel-specific boundary displacement method based on St. Venant’s principle. Utilizing the results from the transient dynamic analysis of the entire lumbar spine as boundary conditions, this study simulates the dynamic behavior of osteon in each segment of the spine on a microscopic scale. The macroscopic results of the transient dynamic analysis showed that the rates of change in dynamic displacement amplitude relative to static displacement amplitude for the L1-L5 vertebrae were 212.60%, 242.11%, 314.80%, 1.17%, and 3.75%, respectively. The change in displacement amplitude under dynamic load relative to static load was highest for the L3 vertebra, as observed in the macroscopic model. The stress and strain values in the microscopic osteon of each lumbar spine segment under sinusoidal periodic loading were higher than those in the macroscopic osteon. In the microscopic bone unit, the maximum stress occurred at the cement line during the peak stress moment, while the minimum stress was observed at the innermost bone plate during the moment of minimum stress. Under dynamic loading, the microscopic bone osteon demonstrated a cyclic stress and strain response, with variations observed in different components of the osteon. These findings provide new insights into the biomechanical behavior of the lumbar spine in a vibration environment.