Multiple Vertebrae Research Articles

Automated detection, labelling and radiological grading of clinical spinal MRIs

Spinal magnetic resonance (MR) scans are a vital tool for diagnosing the cause of back pain for many diseases and conditions. However, interpreting clinically useful information from these scans can be challenging, time-consuming and hard to reproduce across different radiologists. In this paper, we alleviate these problems by introducing a multi-stage automated pipeline for analysing spinal MR scans. This pipeline first detects and labels vertebral bodies across several commonly used sequences (e.g. T1w, T2w and STIR) and fields of view (e.g. lumbar, cervical, whole spine). Using these detections it then performs automated diagnosis for several spinal disorders, including intervertebral disc degenerative changes in T1w and T2w lumbar scans, and spinal metastases, cord compression and vertebral fractures. To achieve this, we propose a new method of vertebrae detection and labelling, using vector fields to group together detected vertebral landmarks and a language-modelling inspired beam search to determine the corresponding levels of the detections. We also employ a new transformer-based architecture to perform radiological grading which incorporates context from multiple vertebrae and sequences, as a real radiologist would. The performance of each stage of the pipeline is tested in isolation on several clinical datasets, each consisting of 66 to 421 scans. The outputs are compared to manual annotations of expert radiologists, demonstrating accurate vertebrae detection across a range of scan parameters. Similarly, the model’s grading predictions for various types of disc degeneration and detection of spinal metastases closely match those of an expert radiologist. To aid future research, our code and trained models are made publicly available.

Detection and Analysis of Genes Affecting the Number of Thoracic Vertebrae in Licha Black Pigs.

The number of thoracic vertebrae (NTV) in pigs is an important economic trait that significantly influences pork production. While the Licha black pig is a well-known Chinese pig breed with multiple thoracic vertebrae, the genetic mechanism is still unknown. Here, we performed a selective signal analysis on the genome of Licha black pigs, comparing individuals with 15 NTV versus those with 16 NTV to better understand functional genes associated with NTV. A total of 2265 selection signal regions were detected across the genome, including 527 genes and 1073 QTL that overlapped with the selection signal regions. Functional enrichment analysis revealed that LRP5 and SP5 genes were involved in biological processes such as bone morphogenesis and Wnt protein binding. Furthermore, three genes, LRP8, DEF6, and SCUBE3, associated with osteoblast differentiation and bone formation, were located within or close to the QTL related to bone development and vertebrae number. These five genes were hypothesized to be potential candidates for regulating the NTV trait in Licha black pigs. Our findings revealed several candidate genes that play crucial roles in NTV regulation and provide a theoretical foundation to understand the genetic mechanism of the NTV trait in pig breeding.

Segmental Stabilization of Multilevel Noncontiguous Spinal Fracture

Abstract A multilevel noncontiguous spinal fracture (MNSF) is defined as a spinal injury at two or more levels separated by single or multiple normal vertebrae. We report a case of MNSF having D6, D11, and D12 fractures with AIS-ASIA B. The patient underwent segmented posterior stabilization from D5 to L1 along with decompression at D11. Secondary or tertiary lesions are always overlooked during preliminary physical examination and investigations. Early diagnosis of these lesions and definitive planning before surgery will prevent complication-related lesions or hardware.

An illustrated atlas of the vertebral morphology of extant non-caenophidian snakes, with special emphasis on the cloacal and caudal portions of the column

AbstractWe here present a thorough documentation of the vertebral morphology and intracolumnar variation across non-caenophidian snakes. Our studied sample of multiple individuals covers a large number of genera (67) and species (120), pertaining to almost all extant non-caenophidian families. Detailed figuring of multiple vertebrae across the trunk, cloacal, and caudal series for many different individuals / taxa documents the intracolumnar, intraspecific, and interspecific variation. An emphasis is given in the trunk-to-caudal transition and the pattern of the subcentral structures in that region of the column. Extant non-caenophidian snakes show an astonishing diversity of vertebral morphologies. Diagnostic vertebral features for extant families and many genera are given, though admittedly vertebral distinction among genera in certain groups remains a difficult task. A massive compilation of vertebral counts for 270 species, pertaining to 78 different genera (i.e., almost all known valid genera) and encompassing all extant non-caenophidian families, is provided based on our observations as well as an extensive literature overview. More particularly, for many taxa, detailed vertebral counts are explicitly given for the trunk, cloacal, and caudal portions of the column. Extant non-caenophidian snakes witness an extremely wide range of counts of vertebrae, ranging from 115 up to 546. A discussion on the diagnostic taxonomic utility and potential phylogenetic value of certain vertebral structures is provided. Comparisons of the subcentral structures of the cloacal and caudal vertebral series are also made with caenophidian lineages. We anticipate that this illustrative guide will set the stage for more vertebral descriptions in herpetological works but will also be of significant aid for taxonomic identifications in ophidian palaeontology and archaeozoology.

An Artificial Intelligence Model for Predicting Trauma Mortality Among Emergency Department Patients in South Korea: Retrospective Cohort Study.

Within the trauma system, the emergency department (ED) is the hospital's first contact and is vital for allocating medical resources. However, there is generally limited information about patients that die in the ED. The aim of this study was to develop an artificial intelligence (AI) model to predict trauma mortality and analyze pertinent mortality factors for all patients visiting the ED. We used the Korean National Emergency Department Information System (NEDIS) data set (N=6,536,306), incorporating over 400 hospitals between 2016 and 2019. We included the International Classification of Disease 10th Revision (ICD-10) codes and chose the following input features to predict ED patient mortality: age, sex, intentionality, injury, emergent symptom, Alert/Verbal/Painful/Unresponsive (AVPU) scale, Korean Triage and Acuity Scale (KTAS), and vital signs. We compared three different feature set performances for AI input: all features (n=921), ICD-10 features (n=878), and features excluding ICD-10 codes (n=43). We devised various machine learning models with an ensemble approach via 5-fold cross-validation and compared the performance of each model with that of traditional prediction models. Lastly, we investigated explainable AI feature effects and deployed our final AI model on a public website, providing access to our mortality prediction results among patients visiting the ED. Our proposed AI model with the all-feature set achieved the highest area under the receiver operating characteristic curve (AUROC) of 0.9974 (adaptive boosting [AdaBoost], AdaBoost + light gradient boosting machine [LightGBM]: Ensemble), outperforming other state-of-the-art machine learning and traditional prediction models, including extreme gradient boosting (AUROC=0.9972), LightGBM (AUROC=0.9973), ICD-based injury severity scores (AUC=0.9328 for the inclusive model and AUROC=0.9567 for the exclusive model), and KTAS (AUROC=0.9405). In addition, our proposed AI model outperformed a cutting-edge AI model designed for in-hospital mortality prediction (AUROC=0.7675) for all ED visitors. From the AI model, we also discovered that age and unresponsiveness (coma) were the top two mortality predictors among patients visiting the ED, followed by oxygen saturation, multiple rib fractures (ICD-10 code S224), painful response (stupor, semicoma), and lumbar vertebra fracture (ICD-10 code S320). Our proposed AI model exhibits remarkable accuracy in predicting ED mortality. Including the necessity for external validation, a large nationwide data set would provide a more accurate model and minimize overfitting. We anticipate that our AI-based risk calculator tool will substantially aid health care providers, particularly regarding triage and early diagnosis for trauma patients.

Comparison of acute single versus multiple osteoporotic vertebral compression fractures in radiographic characteristic and bone fragility

BackgroundOsteoporotic vertebral compression fractures (OVCF) are common in aged population with bone fragility. This study aimed to identify the radiographic and bone fragility characteristic of acute single and multiple OVCF.MethodsOVCF patients hospitalized in a spine center between June 2016 and October 2020 were retrospectively studied. Demographics, comorbidity, bone mineral density, spine trauma, duration of pre-hospital back pain, anatomical location and distribution pattern of OVCF, extent of vertebral marrow edema, and degree of vertebral compression of patients with multi-segment vertebral fractures (MSVF) were summarized and compared to those with single segment vertebral fractures (SSVF).ResultsA total of 1182 patients with 1530 acute fractured vertebrae were included. There were 944 SSVF (79.9%) and 238 MSVF (20.1%) simultaneously involving two (MSVF-2) or three and more vertebra (MSVF-3/m). The Female-Male ratio was 4.4 and differed not significantly between SSVF and MSVF. Females in SSVF were younger than males while MSVF-2 tended to occur in older females. L1, T12, and L2 were the three most frequently fractured vertebra and MSVF involved more vertebra in thoracic and lumbar spine. 31.1% in MSVF-2 and 83.1% in MSVF-3/m had at least two vertebral fractures in adjacent. The fractured thoracolumbar vertebra in MSVF was less compressed than that in SSVF. Apparent spine trauma was reported by 61.4% of SSVF, 44.1% of MSVF-2, and 36.3% of MSVF-3/m, while early hospitalization with pre-hospital back pain ≤ 1 week was 58.9% in SSVF, 45.3% in MSVF-2, and 25.9% in MSVF-3/m. Only females aged 70–80 years old in MSVF-3/m showed lower baseline bone mineral density than in MSVF-2 and SSVF. MSVF were not associated with increased comorbidity of hypertension, diabetes, coronary heart disease, cerebral infarction, and chronic pulmonary disease.Conclusions20% of acute OVCF can involve multiple vertebra without significant spine trauma or lower baseline bone mineral density. Multiple OVCF tend to occur in adjacent vertebra with less thoracolumbar vertebral compression but longer duration of pre-hospital back pain.

Fast 3D YOLOv3 based standard plane regression of vertebral bodies in intra-operative CBCT volumes.

Mobile C-arm systems represent the standard imaging devices within the field of spine surgery. In addition to 2D imaging, they allow for 3D scans while preserving unrestricted patient access. For viewing, the acquired volumes are adjusted such that their anatomical standard planes align with the axes of the viewing modality. This difficult and time-consuming step is currently performed manually by the leading surgeon. This process is automatized within this work to improve the usability of C-arm systems. Thereby, the spinal region consisting of multiple vertebrae and the standard planes of all vertebrae being of interest to the surgeon need to be taken into account. An object detection algorithm based on the you only look once version 3 architecture, adapted to 3D inputs, is compared with a segmentation-based approach employing a 3D U-Net. Both algorithms are trained on a dataset of 440 and tested on 218 spinal volumes. Although the detection-based algorithm is slightly inferior concerning the detection (91% versus 97% accuracy), localization (1.26mm versus 0.74mm error) and alignment accuracy (5.00deg versus 4.73deg error), it outperforms the segmentation-based one in terms of speed (5s versus 38s). Both algorithms show similar good results. However, the speed gain of the detection-based algorithm, resulting in a run time of 5s, makes it more suitable for usage in an intra-operative scenario.

Pregnancy- and lactation-induced osteoporosis: a social-media-based survey

BackgroundPregnancy- and lactation-induced osteoporosis (PLO) presenting as spinal fractures is rare, and the spectrum of clinical presentation, risk factors and pathophysiology are incompletely understood. The aim of this study was to delineate clinical parameters, risk factors and osteoporosis-related quality of life (QOL) of women with PLO.MethodsParticipants of a social-media (WhatsApp) PLO group and mothers of a parents’ WhatsApp group (control group) were offered to fill a questionnaire, including an osteoporosis-related QOL section. The groups were compared using the independent Students t test for numerical variables, and the Chi-square test or Fisher’s exact test for categorical variables.ResultsTwenty-seven women with PLO and 43 in the control group (aged 36.2 ± 4.7 and 38.8 ± 4.3 years, respectively, p = 0.04) participated. Among women with PLO, more than 5 vertebrae were involved in 13 (48%), 4 vertebrae in 6 (22%), and 3 or fewer vertebrae in 8 (30%). Among the 24 women with relevant data, 21 (88%) had nontraumatic fractures; 3 (13%) women had fractures during pregnancy, and the remaining during the early postpartum period. Diagnosis was delayed for over 16 weeks for 11 (41%) women; 16 (67%) received teriparatide. Significantly lower proportions of women in the PLO group engaged in physical activity over 2 hours/week, before and during pregnancy (37 vs. 67%, p < 0.015 and 11 vs. 44%, p < 0.003, respectively). A lower proportion of the PLO than the control group reported calcium supplementation during pregnancy (7% vs. 30%, p = 0.03) and a higher proportion reported treatment with low-molecular-weight-heparin during pregnancy (p = 0.03). Eighteen (67%) of the PLO group expressed fear of fractures and 15 (56%) fear of falls, compared to none and 2%, respectively, of the control group (p < 0.00001 for both).ConclusionsMost of the women with PLO who responded to our survey reported spinal fractures involving multiple vertebrae, delayed diagnosis, and treatment with teriparatide. Compared to a control group, they reported less physical activity and impaired QOL. For this uncommon yet severe condition, a multidisciplinary effort should be exerted for early identification and treatment, to alleviate back pain, prevent subsequent fractures and improve QOL.

SpineRegNet: Spine Registration Network for volumetric MR and CT image by the joint estimation of an affine-elastic deformation field.

Spine registration for volumetric magnetic resonance (MR) and computed tomography (CT) images plays a significant role in surgical planning and surgical navigation system for the radiofrequency ablation of spine intervertebral discs. The affine transformation of each vertebra and elastic deformation of the intervertebral disc exist at the same time. This situation is a major challenge in spine registration. Existing spinal image registration methods failed to solve the optimal affine-elastic deformation field (AEDF) simultaneously, only consider the overall rigid or elastic alignment with the help of a manual spine mask, and encounter difficulty in meeting the accuracy requirements of clinical registration application. In this study, we propose a novel affine-elastic registration framework named SpineRegNet. The SpineRegNet consists of a Multiple Affine Matrices Estimation (MAME) Module for multiple vertebrae alignment, an Affine-Elastic Fusion (AEF) Module for joint estimation of the overall AEDF, and a Local Rigidity Constraint (LRC) Module for preserving the rigidity of each vertebra. Experiments on T2-weighted volumetric MR and CT images show that the proposed approach achieves impressive performance with mean Dice similarity coefficients of 91.36%, 81.60%, and 83.08% for the mask of the vertebrae on Datasets A-C, respectively. The proposed technique does not require a mask or manual participation during the tests and provides a useful tool for clinical spinal disease surgical planning and surgical navigation systems.

A retrospective study on bone metastasis in dogs with advanced-stage solid cancer.

To review clinical characteristics, treatment, outcome and prognostic factors in dogs with solid cancer-bearing bone metastases. Records were reviewed from dogs with histologically-proven solid cancer and bone metastases. Clinicopathologic variables, bone metastases characteristics and skeletal-related events were recorded. Endpoints were time to bone metastases and survival. Fifty dogs were included, 20 of them with synchronous and 30 of them with metachronous bone metastases. In the latter group, median time to diagnosis of bone metastases was 210 days (range, 30 to 1835). Most common primary cancer locations included mammary gland (n=6), spleen (n=5) and tonsil (n=5). Most common histotypes were carcinoma (n=32) and hemangiosarcoma (n=10). Nineteen dogs had multiple bones involvement, with humeri and vertebrae more commonly affected. Twenty-four dogs received antitumoural therapy, five symptomatic treatment and 21 were not treated. Overall median survival after bone metastases diagnosis was 30 days (range, 11 to 49); 83% of dogs died because of skeletal-related events. Lack of antitumoural therapy was significantly associated with shorter survival (hazard ratio: 2.7; 95% confidence interval: 1.3 to 5.6) and with increased risk of skeletal-related death (hazard ratio: 3.3; 95% confidence interval: 1.4 to 7.4). Dogs with endocrine/neuroendocrine tumours (odds ratio: 8.8; 95% confidence interval: 1.2 to 63.9), without appendicular metastases (odds ratio: 5.1; 95% confidence interval: 1.0 to 25.8), without extra-skeletal metastases (odds ratio: 5.2; 95% confidence interval: 1.1 to 24.5) and receiving antitumoural therapy (odds ratio: 14.8; 95% confidence interval: 1.7 to 131.4) had an increased chance of surviving more than 100 days. Bone metastases in dogs with solid cancers are associated with poor prognosis and a high risk of skeletal-related events. Treatment appears to have an impact on survival.

Craniofacial dysmorphism, skeletal anomalies, and impaired intellectual development syndrome-1 in two new patients with the same homozygous TMCO1 variant and review of the literature

Craniofacial dysmorphism, skeletal anomalies, and impaired intellectual development syndrome-1 (CFSMR1; OMIM#213980) is a rare autosomal recessive disorder characterized by the clinical triad of developmental delay and/or intellectual disability, a typical facial gestalt with brachycephaly, highly-arched bushy eyebrows, synophrys, hypertelorism, wide nasal bridge, and short nose, as well as multiple vertebrae and rib malformations, such as bifid and fused ribs and abnormal vertebral segmentation and fusion. Biallelic loss-of-function variants in TMCO1 cause CFSMR1. We report on two unrelated Egyptian patients with a phenotype suggestive of CFSMR. Single whole-exome sequencing in patient 1 and Sanger sequencing of TMCO1 in patient 2 revealed the same homozygous TMCO1 nonsense variant c.187C > T/p.(Arg63*) in both affected individuals; patients’ healthy parents were heterozygous carriers of the variant. Congenital hearing loss in patients 1 and 2 is an occasional finding in individuals affected by CFSMR. Camptodactyly and syndactyly, which were noted in patient 2, have not or rarely been reported in CFSMR. Review of the literature revealed a total of 30 individuals with the clinically recognizable and unique phenotype of CFSMR1, including the patients reported here, who all carried biallelic TMCO1 variants. Six different TMCO1 variants have been reported in the 30 patients from 14 families, comprising three nonsense, two 2-bp deletions, and a splice donor site variant. All disease-associated TMCO1 variants likely represent null alleles resulting in absence of the encoded protein. TMCO1 has been proposed to act as a Ca2+ channel, while other data revealed TMCO1 as a mitochondrial protein and a component of the translocon at the endoplasmic reticulum, a cellular machinery important for the biogenesis of multi-pass membrane proteins. RAB5IF/C20orf24 has recently been identified as causative gene for craniofacial dysmorphism, skeletal anomalies, and impaired intellectual development syndrome-2 (CFSMR2; OMIM#616994). Heterodimerization of RAB5IF/C20orf24 and TMCO1 and their interdependence may suggest a pathophysiological role of ER-mitochondria interaction underlying CFSMR.

Neurosurgical management of vertebral lesions in pediatric chronic recurrent multifocal osteomyelitis: patient series.

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare pediatric autoinflammatory disorder involving 2 or more inflammatory bone lesions separated in time and space associated with pathological vertebral fractures. There are no current guidelines for the role of pediatric spine surgeons in the management of this condition. The authors demonstrate the importance of close and early involvement of neurosurgeons in caring for patients with CRMO with vertebral involvement. Fifty-six pediatric patients with clinical and radiographic evidence of CRMO were identified and clinical, radiographic, laboratory, and histopathological data were reviewed. All were evaluated via Jansson and Bristol CRMO diagnostic criteria. Ten had radiographic evidence of vertebral involvement (17.9%). Nine of these had multifocal disease. Five patients had multiple vertebrae affected. Six patients were evaluated for possible surgical intervention and one required intervention due to vertebra plana leading to a progressive kyphotic deformity and significant spinal canal stenosis. In conjunction with management by the primary pediatric rheumatology team using nonsteroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, immunotherapies, and bisphosphonates, given the risk of pathological fractures and potential resulting long-term neurological deficits, the authors recommend close monitoring and management by pediatric spine surgeons for any patient with CRMO with vertebral lesions.

Monte Carlo Dosimetric Study of Percutaneous Vertebroplasty and Brachytherapy for the Treatment of Spinal Metastases.

Percutaneous vertebroplasty employs bone cement for injecting into the fractured vertebral body (VB) caused by spinal metastases. Radioactive bone cement and also brachytherapy seeds have been utilized to suppress the tumor growth in the VB. This study aims to investigate the dose distributions of low-energy brachytherapy seeds, and to compare them to those of radioactive bone cement, by Monte Carlo simulation. In this simulation study, nine CT scan images were imported in Geant4. For the simulation of brachytherapy, I-125, Cs-131, or Pd-103 seeds were positioned in the VB, and for the simulation of vertebroplasty, the VB was filled by a radioactive cement loaded by P-32, Ho-166, Y-90, or Sm-153 radioisotopes. The dose-volume histograms of the VB, and the spinal cord (SC) were obtained after segmentation, considering that the reference dose is the minimum dose covered 95% of the VB. The SC sparing was improved by using beta-emitting cement because of their steep gradient dose distribution. I-125 seeds and Y-90 radioisotope showed better VB coverage for brachytherapy and vertebroplasty techniques, respectively. Pd-103 seeds and P-32 radioisotope showed better SC sparing for brachytherapy and vertebroplasty, respectively. The minimum mean doses that covered 100% of the VB were 62.0%, 56.5%, and 45.0% for I-125, Cs-131, and Pd-103 seeds, and 28.3%, 28.6%, 32.9%, and 17.7%, for P-32, Ho-166, Y-90, and Sm-153 sources, respectively. I-125 and Cs-131 seeds may be useful for large tumors filling the entire VB, and also for the extended tumors invading multiple vertebrae. Beta-emitting bone cement is recommended for tumors located near the SC.

Imaging features of chronic recurrent multifocal osteomyelitis (CRMO) involving the vertebral column of a lemur with subsequent paraplegia due to pathological fractures

A seven-year-old, female ring-tailed lemur was referred for progressive non-ambulatory paraplegia. A computed tomographic (CT) scan of the whole body revealed multifocal lytic lesions involving multiple vertebrae and several pathological vertebral fractures. Necropsy and histopathology identified pyogranulomatous osteomyelitis. The imaging and histopathological findings resemble chronic recurrent multifocal osteomyelitis described in human medicine.

Neuroblastoma Presentation With Multiple Cranial Nerve Involvement

Objective NA. Background We report a case of neuroblastoma, a pediatric neuroendocrine tumor of the sympathetic nervous system, in a 3-year-old female with multiple cranial nerve involvement. Design/Methods A 3-year-old afebrile, lethargic female presented with bilateral eyelid droop, right head tilt, slurred speech, gagging, abnormal walking and no bowel movement. Neurological examination noted bilateral ptosis, dysarthria, left tongue deviation, proximal weakness in upper and lower extremities, areflexia in biceps and patellar tendons, dysmetria, and wide-based gait. MRI of the brain showed heterogeneous appearance of the clivus and MRI of the spine showed right adrenal mass and heterogeneous enhancement of multiple vertebrae, suggesting possible metastatic disease. Serum and cerebrospinal studies were unremarkable. Patient was treated with intravenous methylprednisolone and plasmapheresis for suspected paraneoplastic syndrome; however, she continued to clinically progress. Adrenal mass biopsy results and elevated urine VMA and HVA levels were consistent with the diagnosis of neuroblastoma. Nuclear imaging and meta-iodobenzylguanidine scan were negative. Paraneoplastic panels and Lambert Eaton panel were negative for autoantibodies. Total resection of the abdominal mass and right adrenal gland with continued steroid taper, resulted in reported near total symptom resolution. Results Our patient presented with antibody negative paraneoplastic polyneuropathy due to neuroblastoma. Cranial nerve involvement in neuroblastoma can result from tumor involvement of the sympathetic chain, paraneoplastic syndromes, or metastasis to the skull. Our patient's initial imaging suggested potential metastatic or inflammatory involvement of the clivus, suspected of causing her cranial nerve symptoms. However, nuclear studies were negative for metastatic disease and patient's symptoms resolved after resection of the main mass suggesting a paraneoplastic etiology. Although her paraneoplastic panel and Lambert-Eaton panel were negative for common associated antibodies, it is likely an unmeasured autoantibody, cytokine, hormones, or peptide was at play. Conclusions Neuroblastoma should be considered as a differential for a neurological presentation involving multiple cranial nerves in a child.

Chest radiograph prevalence of vertebral deformity among young and middle-aged population of mixed city dwellers and rural residents.

To interpret the importance of minimal and mild vertebral deformities (VDs) among elderly subjects, we need to know their prevalence among mostly non-osteoporotic subjects. We retrospectively analyzed VDs among 408 female and 374 male patients who had lateral chest radiographs due to mild illness or for routine healthcheck, all with indications other than spine disorders or metabolic disorders. The study subjects were divided into four age groups, i.e., ≤20, 20-34, 35-44, and ≥45 years. For those aged >20 years, 27.2% females had family roots from farming communities, and 26.4% males had the history of being a farmer or physical laborer (this was 36.1% for males aged ≥45 years). Fracture shaped vertebral deformities (FSVDs) were VDs radiographically indistinguishable from vertebral fracture. Acquired short vertebrae were those with decreased vertebral anterior and middle heights, while without anterior wedging or bi-concave changes, and the diagnosis required at least two adjacent short vertebrae in the same subject. Congenital VDs were observed in four cases (three males, one female). In the age group of ≤20, 20-34, 35-44, and ≥45 years, females had any FSVD prevalence of 13.4%, 8.3%, 11.8%, 25.8% respectively, while the prevalence was 29.3%, 26%, 34.3%, 44.8% respectively for males. From the female ≤20 years group to the 21-34 years group, cases involved multiple vertebrae decreased from 53.8% to 16.7%. For cases ≤34 years, no female case had ≥ mild FSVD (which was defined to have ≥20% vertebral height loss), while five male cases had ≥ mild FSVD. For the 35-44 years group, vertebral endplate depression was noted among 2.0% of the females and 2.9% of the males. Among the cases aged ≤44 years, there was only one male and one female had acquired short vertebrae. For the male cases, acquired short vertebrae prevalence was 15.6% in the group of ≥45 years. FSVD is common among young and middle-aged population (≤44 years) assumed with normal bone strength, and with a higher FSVD prevalence among men. FSVD may heal among younger subjects, and physical labor may increase VD prevalence.

Differences in spine volumetric bone mineral density between grade 1 vertebral fracture and non-fractured participants in the China action on spine and hip status study

This study evaluated the prevalence of vertebral fractures (VF) in middle-aged and elderly Chinese men and women and explored the differences in lumbar spine volumetric bone mineral density (vBMD) derived from quantitative CT (QCT) between those with a grade 1 vertebral fracture and non-fractured individuals. 3,457 participants were enrolled in the China Action on Spine and Hip Status (CASH) study and had upper abdominal CT examinations. Vertebral fractures were identified by Genant's semi-quantitative method from lateral CT scout views or CT sagittal views. L1-3 vBMD was measured by Mindways QCT Pro v5.0 software. The characteristics of different fracture severity groups were compared using one-way ANOVA, independent-samples t-tests, and Kruskal-Wallis H-tests. 1267 males (aged 62.77 ± 9.20 years) and 2170 females (aged 61.41 ± 9.01 years) were included in the analysis. In men, the prevalence of VF increased from 14.7% at age&lt;50 years to 23.2% at age ≥70 years, and in women from 5.1% at age&lt;50 years to 33.0% at age ≥70 years. Differences in mean age and vBMD were found between the different fracture grade groups. After age stratification, vBMD differences in men aged &lt; 50 years old disappeared (p = 0.162) but remained in the older age bands. There was no significant difference in mean vBMD between those with multiple mild fractures and those with a single mild fracture. In women, the prevalence of VF increased rapidly after age 50, while it grew more slowly in men. In general, with the exception of men &lt;50 years old, participants with a grade 1 VF had lower vBMD than non-fractured individuals. The majority of women younger than 50 with a grade 1 VF had normal bone mass. We recommend that a vertebral height reduction ratio of &lt;25% be diagnosed as a deformity rather than a fracture in people under the age of 50. The presence of multiple mild fractured vertebrae does not imply lower BMD.

Advanced Polyostotic Fibrous Dysplasia

Polyostotic fibrous dysplasia is a disorder that features the replacement of multiple areas of bone with fibrous tissue, which may cause fractures and deformity. It begins in childhood and progresses onward, affecting both sexes equally. A 23-year-old male presented with recurrent fractures of all long bones and multiple vertebrae with low trauma. X-ray showed extensive multilocular cystic lesions with ground-glass diffuse refractions throughout all long bones, multiple fracture lines and dislocation of joints, scoliosis, and compression of multiple vertebrae. Severe cortical thinning is also seen in all bones. He was managed with bisphosphonate, and significant improvement was observed.

Thoracic and lumbar spine trauma classification systems fail to predict post-traumatic kyphotic deformity

BackgroundPost-traumatic kyphosis of the thoracic and lumbar spine can lead to pain and decreased function. MRI has been advocated to assess ligament integrity and risk of kyphosis. MethodsAll thoracic and lumbar spine MRI performed for evaluation of trauma over a 3-year period at a single institution were reviewed. Patients were included if there was an MRI showing a vertebral body fracture and follow-up radiographs. Two observers retrospectively reviewed all radiographs, CT and MRI scans, and classified injuries based on the Denis, TLICS, AO and load sharing classification systems. Change in kyphosis between injury and follow-up studies was measured. The initial radiology reports made at time of patient injury were compared to the retrospective interpretations. ResultsThere were 67 separate injuries in 62 patients. Kyphosis measuring ≥ 10° developed despite an intact PLC in 6/14 nonoperative cases, and 3/7 surgically treated cases; when PLC was partially injured, it developed in 6/10 cases (8 treated nonoperatively, 2 treated operatively. Thirty injuries had complete disruption of PLC by MRI, 24 treated with fusion. Kyphosis ≥ 10° developed in 3/6 treated nonoperatively, and 8/24 treated with fusion. Development of kyphosis was independent of degree of vertebral body comminution. It developed equally in patients with Grade 2 and Grade 3 Denis injuries. It developed in patients with intact PLC when multiple vertebrae were involved and/or there was compressive injury to anterior longitudinal ligament (ALL). There was high interobserver variability in assessment of severity of ligamentous injury on MRI. ConclusionsClassification systems of thoracic and lumbar spine injury and integrity of the PLC failed to predict the risk of development of post-traumatic kyphotic deformity.

Computational model predicts risk of spinal screw loosening in patients

PurposePedicle screw loosening is a frequent complication in lumbar spine fixation, most commonly among patients with poor bone quality. Determining patients at high risk for insufficient implant stability would allow clinicians to adapt the treatment accordingly. The aim of this study was to develop a computational model for quantitative and reliable assessment of the risk of screw loosening.MethodsA cohort of patient vertebrae with diagnosed screw loosening was juxtaposed to a control group with stable fusion. Imaging data from the two cohorts were used to generate patient-specific biomechanical models of lumbar instrumented vertebral bodies. Single-level finite element models loading the screw in axial or caudo-cranial direction were generated. Further, multi-level models incorporating individualized joint loading were created.ResultsThe simulation results indicate that there is no association between screw pull-out strength and the manifestation of implant loosening (p = 0.8). For patient models incorporating multiple instrumented vertebrae, CT-values and stress in the bone were significantly different between loose screws and non-loose screws (p = 0.017 and p = 0.029, for CT-values and stress, respectively). However, very high distinction (p = 0.001) and predictability (R2Pseudo = 0.358, AUC = 0.85) were achieved when considering the relationship between local bone strength and the predicted stress (loading factor). Screws surrounded by bone with a loading factor higher than 25% were likely to be loose, while the chances of screw loosening were close to 0 with a loading factor below 15%.ConclusionThe use of a biomechanics-based score for risk assessment of implant fixation failure might represent a paradigm shift in addressing screw loosening after spondylodesis surgery.