Anterior Posterior Spine Research Articles

Integrating biplane information and context for spine landmark detection.

Spine landmark detection is of great significance for spinal morphological parameter assessment and three-dimensional reconstruction of the human spine. This detection task generally involves locating spine landmarks in the anterior-posterior (AP) and lateral (LAT) X-rays of the spine. Recently, the two-stage methods for AP spine landmark detection achieve better performance. However, these methods perform poorly in LAT landmark detection because of poor detection accuracy of LAT vertebra due to occlusion. To solve this problem, this paper proposes a new two-stage spine landmark detection method. In the first stage, this paper propose a biplane vertebra detection network for vertebra detection on AP and X-rays simultaneously. Then an epipolar module and a context enhancement module are proposed to assist LAT vertebra detection by using the biplane information and the context information of the vertebrae respectively. In the second stage, the landmarks can be obtained in the detected vertebrae area. Extensive experiment results conducted on a dataset containing 328 pairs of X-rays demonstrate that our method improves the vertebra and landmark detection accuracy.

Correlation of Entrance Skin Dose with Body Mass Index of Patients Undergoing Routing X-Ray Examination at Federal Teaching Hospital Gombe, North-Eastern Nigeria

This study was conducted to assess the amount of dose received by patients undergoing routine x-ray examinations at Federal Teaching Hospital, Gombe in Gombe State, Nigeria. Entrance skin doses (ESDs) for different kinds of x-ray procedures, include Posterior Anterior (PA) and Lateral (Lat) chest, Anterior Posterior (AP) Abdomen, AP pelvis, AP and Lat lumber spine and PA and Lat skull were assessed using standard exposure parameters. Data were obtained from eighty (80) patients who were exposed to diagnostic X-ray during their regular X-ray examinations. The patients’ age ranged from 1 to 80 years, while the weight was between 20kg and 100kg and height of these patients was between 95.0cm and 171cm. The skin dose of each patient was evaluated using a formula, based on the radiographic exposure parameters of kVp, mAS, SSD, the X-ray tube and the total filtration of the beams. The mean entrance skin dose ranged from 0.016 mGy to 3.168 mGy. Eventually, the ESDs measured for these x-ray procedures were found to be below the maximum permissible limits set by Nigeria Basic Ionizing Radiation Regulation and all the examinations conducted showed that there is a good correlation between the entrance skin doses and body mass index for the studied subjects. This implies that patients with higher body mass index will received more dose than the patients with low body mass index.

A 2-Year Longitudinal Study of Bone Mineral Density in Collegiate Distance Runners.

Brimacomb, OE, Martinez, MP, McCormack, WP, and Almstedt, HC. A 2-year longitudinal study of bone mineral density in collegiate distance runners. J Strength Cond Res 37(8): 1654-1659, 2023-The purpose of this investigation was to examine changes in bone mineral density (BMD) of male and female collegiate distance runners over 2 years. Bone mineral density of 29 collegiate distance runners (16 men and 13 women) were measured 5 times over 24 months using dual-energy x-ray absorptiometry (DXA) at the anterior-posterior (AP) and lateral (LAT) spine, femoral neck (FN), total hip (TH), whole body (WB), and ultradistal (UD) forearm. Repeated-measures multivariate analysis of covariance, with bone-free lean mass (BFLM) as covariate, was used to compare mean BMD values. Adjusted for BFLM, there were no significant differences ( p > 0.05) in BMD at any site between sexes. There were no significant differences at the AP or LAT spine, FN, or WB between visit 1 and 5 for either sex. There was a significant increase in BMD ( p = 0.044) at the UD forearm over 2 years in males. However, 56% of the men ( n = 9) had a Z-score < -1.0 at the UD forearm. Seven of 11 women had Z-scores < -1.0 at the LAT spine and 4 of 13 had Z-scores < -1.0 at the AP spine. There were no significant changes in BMD at any site over the 2-year time frame, except a significant increase in BMD at the nondominant forearm in men. The spine appears to be an area of concern for women in this study when examining Z-score results. Coaches and medical staff need to continually educate collegiate endurance athletes about the importance of achieving and maintaining BMD through their college years.

The mystery of morphometric measurements of the coxal bone

Coxal bone, which is included in the structure of the pelvic skeleton, is in close relationship with the pelvic organs and great vessels. The aim of this study is to show the harmony between morphometric measurements using the correlation technique, based on the idea that the proportional harmony in different parts of our body will also be in the coxal bone. In the study, 95 dry coxal bone belonging to the Turkish population were examined. In dry bones of adults, the distance between anterior superior iliac spine and posterior superior iliac spine (A), distance between anterior inferior iliac spine and posterior inferior iliac spine (B), distance between anterior superior iliac spine and anterior inferior iliac spine (C), distance between posterior superior iliac spine and posterior inferior iliac spine (D), symphysial surface length (E), symphysial surface width (F), ischial tuberosity width (G), ischion-pubis arm thickness (H), coxal bone length (I), distance between the symphysial surface and the most protruding part of the ischial tuberosity (J) were measured with caliper. There was no statistical difference in the comparison of different measurements made on the right and left coxal bone in our study. In correlation studies, between (B) and (A) (r: 0.566), between (I) and (A) (r: 0.595), between (J) and (A) (r: 0.600), between (E) and (J) (r: 0.563) measurements showed a positive correlation relationship. In this study, excellent agreement was found in different morphometric measurements in coxal bone.

An efficient ensemble method for detecting spinal curvature type using deep transfer learning and soft voting classifier

Scoliosis is a spinal deformity that negatively affects the body's distribution of weight in several ways. This deformity can be classified as C-shaped or S-shaped. These deformities balance each other at different times, which makes their types undistinguishable. As part of the development of spinal deformity evaluation systems, machine learning algorithms are utilized to evaluate spinal deformities to assist both patients and doctors. There are many types of machine learning algorithms, but deep neural networks can extract features automatically. As a result, they are commonly used for analyzing medical images. A dataset of 1000 private anterior-posterior spine radiographs from Shafa Hospital in Tehran, Iran, was collected and used for this study. Due to the small size of the dataset, deep transfer learning has been employed and the accuracy of pre-trained MobileNetV2, pre-trained Xception, pre-trained ResNet152, pre-trained InceptionV3, and pre-trained DenseNet121 networks have been evaluated. Accordingly, a new approach has been developed based on voting ensemble classifiers together with five pre-trained networks. As a final note, the voting ensemble model which improved spine curvature classification accuracy by about 7% for the test set can be used as a model to develop spine deformity evaluation systems that would assist radiologists, physicians, and orthopedists in evaluating spine deformities.

Does the Rigid External Distraction Device Alter Maxillary Pitch in Cleft Maxillary Distraction?

The rigid external distraction (RED) device is reported to have the ability to three-dimensionally reposition the maxilla. The purpose of this study is to assess the ability of RED to intentionally alter the maxillary pitch. Retrospective cohort study. Institutional practice. A retrospective chart review was completed over the past 12 years and a total of 50 patients met the inclusion criteria. Cephalometric changes and alteration in palatal plane angle. Cephalometric analysis of standardized landmarks was completed on calibrated, standardized lateral cephalograms. Pre-distraction and post-consolidation variables were compared via a two-tailed paired t-test. The mean age at surgery of 12.2 ± 3.2 years. Through distraction osteogenesis (DO), the maxilla was moved anteriorly with a mean distraction distance of 8.4 ± 4.8 mm. The mean change in the angles sella-nasion-A-point angle (SNA), sella-nasion-B-point angle (SNB), and A-point-nasion-B-point angle (ANB) were 10.2 ± 4.8, 0.9 ± 2.7, and 9.3 ± 4.1, respectively. The mean change in the palatal plane angle was −4.4 ± 3.7. The mean change in the vertical position of the anterior nasal spine (ANS) and posterior nasal spine (PNS) in relation to the Frankfort horizontal (FH) were −2.0 ± 4.1 mm and 1.7 ± 3.8 mm, respectively. This study documents short-term findings of RED in a large cleft lip and palate (CLP) population. Despite positioning of distraction eyelets superior to the theoretical center of resistance, a counterclockwise (CCW) rotation of the palatal plane occurred. This suggests that adjunctive methods of vector control should be considered if clockwise (CW) rotation of the palatal plane is intended with the RED device.

Prevalence of scoliosis and impaired pulmonary function in patients with type III osteogenesis imperfecta

PurposeOsteogenesis Imperfecta (OI) is a rare group of congenital genetic disorders that consists of a collagen synthesis defect. The most severe phenotype is type III OI. Characterized by progressive bone deformity, fragility and pulmonary impairment, causing significant morbidity and mortality. Also, multilevel spine deformities are observed, such as scoliosis. The literature on the pathophysiology of pulmonary impairment in relation to scoliosis in these patients is scarce and conflicting. This study aims to determine the prevalence of scoliosis and its relation to pulmonary function in type III OI patients.MethodsThis retrospective cohort study took place between April 2020 and November 2021. Forty-two patients with type III OI were included. Anterior–posterior spine radiographs were evaluated for scoliosis. Pulmonary function was assessed using spirometry and partial pressure of carbon dioxide.ResultsAll 42 patients had scoliosis, with a mean curve of 66° (95% CI of range). Vital lung capacity was decreased, compared to a non-OI population (mean 1.57 L). This was correlated to the degree of scoliosis (st. β − 0.40, P = 0.03), especially in increasing thoracic curves. Restrictive lung pathophysiology was shown in our study population with a mean FEV1/FVC ratio of 0.85.ConclusionsIncreasing thoracic scoliosis was correlated with decreased vital lung capacity in our study population of type III OI patients. High FEV1/FVC ratios found in this study population show restrictive lung pathophysiology. Therefore, it is plausible that the pulmonary impairment found in type III OI patients is a combined issue, partly associated to scoliosis and partly intrinsic to OI.

Evaluation of maxillary and mandibular growth patterns with cephalometric analysis based on cervical vertebral maturation: A Japanese cross-sectional study.

BackgroundAppropriate maxillofacial growth and development evaluation is important for effective orthodontic treatment. Growth evaluation is based on physiological age determined by individual development, but not chronological age. One strategy for determining physiological age is using the cervical vertebral bone age.ObjectivesThis study aimed to clarify the standard size of the upper and lower jawbones in Japanese patients using the cervical vertebral maturation stages (CVMS) as an index and clarify the growth pattern. And to use the cervical spine age as a diagnostic aid in orthodontic treatment.Material and methodsRandom sampling was performed from the outpatients who visited the Orthodontics department, Tokyo Medical and Dental University Dental Hospital, and 400 patients were enrolled before treatment. Lateral cephalometric radiographs were obtained to measure the height and length of the mandible and the maxilla length with cephalometric analysis. Standard values were calculated for each cervical-spine-age group to analyze changes during mandibular and maxillary growth. Furthermore, we compared the differences between males and females. The Kruskal–Wallis test was used to compare cervical-spine-age groups, and the Steel–Dwass test was used for multiple comparisons. The reliability of CVMS was confirmed by calculating the weighted kappa coefficient (κ).Resultsκ for the degree of intra-evaluator agreement and the degree of the inter-evaluator agreement were calculated, and both indicated almost perfect agreement. We found that the distance between the anterior nasal spine (ANS) and posterior nasal spine (PNS) (i.e., ANS–PNS) increased significantly between CVMS II and CVMS III in males. The distance between Articulare (Ar) and Gonion (Go) (i.e., Ar–Go) and the distance between Go and Pogonion (Pog) (i.e., Go–Pog) increased significantly between CVMS III and CVMS IV in males.ConclusionThe findings suggested that CVMS is a reliable indicator of the growth stage of the maxilla and mandible.

Bone mineral density and hip structure changes over one-year in collegiate distance runners and non-athlete controls

Modification of bone is continuous throughout life and influenced by many factors, including physical activity. This study investigated changes in areal bone mineral density (aBMD) and hip structure among male and female collegiate distance runners and non-athlete controls over 12 months. Using dual-energy x-ray absorptiometry (DXA) and hip structure analysis (HSA) software, aBMD at the posterior-anterior (PA) and lateral spine, femoral neck, total hip (TH), whole body (WB), and bone geometry at the narrow neck (NN) of the femur was measured three times over 12 months. HSA included cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), and Z-section modulus (Z). Male runners had significantly higher aBMD at TH and WB and greater CSA, CSMI, and Z than male controls at the end of 12 months. Female controls had higher aBMD at the PA spine than female runners at the end of 12 months. Male runners had significant increases in aBMD at the PA (p = 0.003) and lateral spine (p = 0.002), and TH (p = 0.002), female runners had significant decreases in aBMD at TH (p = 0.015) and WB (p = 0.002), male controls had significant increases in aBMD at the PA spine (p < 0.001) and WB (p < 0.001), and female controls had significant decreases in aBMD at lateral spine and TH (p = 0.008) over the year. When applying covariates of bone-free lean mass and vitamin D, male distance runners demonstrated significant improvement in CSA (3.602 ± 0.139 vs. 3.675 ± 0.122 cm2, p = 0.05), CSMI (3.324 ± 0.200 to 3.467 ± 0.212 cm4, p < 0.05), and Z (1.81 ± 0.08 to 1.87 ± 0.08 cm3, p = 0.05) during the study. No other changes in hip structure occurred over the year. Distance running may be beneficial to aBMD and hip structure in college-age males but not females. Further research is needed on potential influences of weight-bearing activity, energy availability, and hormonal status on aBMD and hip structure in males and females.

Clinical and functional outcome of percutaneous bone marrow injection in delayed union and non-union of long bone fractures

Non-union and Delayed union is still major challenge to the orthopaedic surgeon. Bone grafting are the basic principle in the treatment of non-union and delayed union. However complications is always concern. To minimize this risk, percutaneous bone marrow injection has been suggested as an alternative, this provides a source of oestrogenic cells with osteoinductive effect.Aim: To study percutaneous bone marrow injection in delayed union and non-union of long bone fractures. Materials and methods: The study Sample will be taken from the patients treated in P.D.U. Medical College and Hospital diagnosed as a delayed and non-union on basis of x rays. Under general or spinal anaesthesia, bone marrow was aspirated from the anterior superior iliac crest OR posterior superior iliac spine using bone marrow aspiration needle. The aspirate was injected percutaneously into and around the fracture site under fluoroscopy control. Results: In our study of 30 cases of Delayed union and non-union, 19 (63.33%) cases achieved Union while 11(36.67%) cases Union not achieved by using percutaneous bone marrow injection. Conclusion: Bone marrow injection technique is simple technique which has high oestrogenic potential. This minimally invasive procedure is safe, easy, simple, economical and short procedure.

Limitations of posterior spinal fusion to L5 for flaccid neuromuscular scoliosis focusing on pelvic obliquity.

Retrospective comparison based on the degree of pelvic obliquity (PO). To assess the controversial indications for and limitations of ending the instrumentation for posterior spinal fusion (PSF) at L5 in patients with flaccid neuromuscular scoliosis (fNMS). We reviewed the cases of 45 patients with progressive spinal deformity as a result of fNMS treated by PSF to L5 and followed for an average of 4years postoperatively with adequate clinical and radiological data. Anterior-posterior and lateral whole spine radiographs were evaluated. We divided patients into two groups based on the degree of pelvic obliquity (PO) at the final follow-up. Radiographic data from the two groups were analyzed to identify the indications and limitations of this surgical method focusing on PO. Preoperatively, there were significant differences between the two groups in Cobb angle, PO, thoracolumbar kyphosis, and lumbar lordosis (LL) while sitting; Cobb angle and LL while supine (Supine Cobb, and Supine LL); and major curve flexibility. Multivariate logistic regression analysis identified Supine Cobb and Supine LL as independent risk factors for residual PO at the final follow-up (Supine Cobb: odds ratio, 1.1; 95% confidence interval 1.0-1.2, Supine LL: odds ratio, 0.9; 95% confidence interval 0.8-1.0). Patients with larger preoperative Cobb angle and smaller LL while supine may not achieve adequate spine and pelvic correction and this may lead to deterioration in the PO over time, even after spinal fusion ending at L5.

Assessment of Bone Density by DXA in Poorly Controlled Children With β-Thalassemia: Correction for Hepatic Iron Overload by Manual Analysis

Introduction: Beta thalassemia major (BTM) is characterized by anemia and iron overload, especially with inadequate chelation therapy. Dual energy x-ray absorptiometry software (DXA) may misanalyse bone measurements due to iron deposition in organs such as the liver. Our objective was to study difference between the posterior-anterior spine measurements of bone mineral content (BMC), area (BA) and density (BMD) in poorly chelated beta thalassemia patients with and without inclusion of the liver in the DXA analysis. Methods: We studied hemoglobin and serum ferritin concentrations in 208 patients with BTM (children n = 177, young adults n = 31). Posteroanterior spine measurements BMC, BA and areal BMD were performed using a GE iDXA. Using the tissue point typing feature (EnCore software, version 16), analysis was carried out including and excluding (manually) the iron overloaded liver. Machine generated Z-scores of L1-L4 BMD were used for analysis. Results: The mean age of the study group was 12.9 ± 5.4 yr. Mean hemoglobin and serum ferritin concentrations were 8.0 ± 1.7 g/dl and 2256.9 ± 1978.0 ng/ml, respectively. The mean BMC, BA, and aBMD at the lumbar spine were 23.2 ± 11.4 g, 29.9 ± 8.5 cm2 and 0.736 ± 0.173 g/cm2 respectively with inclusion of liver that is standard machine analysis. After the liver was excluded from the analysis, the mean BMC, BA, and aBMD were 23.9 ± 11.6 g, 30.0 ± 8.6 cm2 and 0.757 ±0.173 g/cm2, respectively and the BMC and aBMD were significantly greater (p < 0.05). Mean BMD Z-score was −1.5 ± 1.2, which significantly (p < 0.05) improved to −1.3 ± 1.2 after exclusion of the liver from the analysis. Conclusion: In poorly chelated patients with thalassemia, inclusion of the iron-overloaded liver in the tissue analysis may exaggerate the deficit in bone parameters. Iron overloaded tissues need to be manually excluded during analysis of the PA spine.

Characterization of lumbar angle, pelvic sagittal balance and flexibility in preschoolers

Introduction: The alignment between anterior superior and inferior posterior iliac spine is related to the lumbar curvature in the sagittal plane. Objective: To characterize the flexibility and angulations of the lumbar spine and the relation with the pelvic tilt in sagittal plane of preschool children. Methods: Participated in the study 138 children with ages ranging from five to six years and enrolled in eight public schools. The evaluation was performed by photogrammetry, pelvic sagittal balance test and limb stretching by fleximeter and Thomas test. Results: There was no difference in the lumbar angle with relation to gender, body mass and age. With regard to pelvic sagittal balance, the majority of preschoolers presented pelvic retroversion (56.6%). Children with pelvic anteversion (4.3%) presented a lower lumbar angle, indicating hyperlordosis. Children with pelvic sagittal balance presented better flexibility of the hamstring muscles than those with the pelvis in retroversion and anteversion. Conclusion: Flexibility was greatest in girls and in five-year-old children. The angle of the lumbar was 24.07°. The pelvis was retroversed in most children, differing from expected for the age group. The lowest angle of the lumbar region corresponded to a pelvis in anteroversion and balanced.

Oral contraceptive use, bone mineral density, and bone turnover markers over 12months in college-aged females.

The purpose of this study was to compare bone mineral density (BMD) and bone turnover markers between combined oral contraceptive (COC) and non-COC users over 12months. COC users (n = 34, age = 19.2 ± 0.5) and non-COC users (n = 28, age = 19.3 ± 0.6) provided serum at baseline, 6months, and 12months. C-terminal telopepetides (CTX) and pro-collagen type 1N-terminal propeptides (P1NP) were determined using ELISA. BMD was measured at the three time points using dual-energy x-ray absorptiometry (DXA). COC users had greater CTX than non-COC users at baseline (18.6 ± 8.2 vs. 13.8 ± 5.3ng/mL, P = 0.021) and 6months (20.4 ± 10.3 vs. 14.2 ± 8.5ng/mL, P = 0.018). Controlling for lean mass, groups were similar in BMD. Over 12months, non-COC users maintained BMD at the spine, while the COC users declined 2.2% in lateral spine BMD (0.773 ± 0.014 to 0.756 ± 0.014g/cm2, P = 0.03) and 0.7% in anterior-posterior spine BMD (1.005 ± 0.015 to 0.998 ± 0.015g/cm2, P = 0.069). Non-COC users increased in BMD of the whole body over 12months (P < 0.001) while COC users had no change. Women who began COCs within 4years after menarche had lower BMD at the hip and whole body. Women taking very low dose COCs (20 mcg ethinyl estradiol, EE) significantly declined in CTX, P1NP, and lateral spine BMD in comparison to participants using low dose COCs (30/35 mcg EE). College-aged women who did not use COCs increased BMD of the whole body, while COC users had elevated bone turnover, declines in spinal BMD, and lack of bone acquisition of the whole body over 12months. Young females who initiate COC use early after menarche may experience skeletal detriments.

Scoliosis and Cardiopulmonary Outcomes in Osteogenesis Imperfecta Patients.

Retrospective clinical study of individuals with osteogenesis imperfecta (OI). To assess the relationship between severity of scoliosis and pulmonary function, and to assess the relationship between restrictive lung disease and self-reported quality of life in individuals with OI. OI is a heritable connective tissue disorder characterized by osteopenia and a predisposition to fracture. Respiratory insufficiency is a leading cause of mortality. Literature on pulmonary function in this population has shown a negative correlation between percent-predicted vital capacity and severity of scoliosis. However, it has been suggested that decreased pulmonary function in OI may be due to intrinsic pulmonary disease, in addition to the impact of vertebral compression fractures and scoliosis. Anterior-posterior spine radiographs and pulmonary function tests from 30 individuals with OI were reviewed. Radiographs were evaluated for scoliosis, defined as a curve ≥ 10°. If more than one curve was present, the largest curve was used. Pulmonary function was defined as the forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio. Restrictive pulmonary disease was defined as FEV1/FVC > 80%, while obstructive disease was defined as FEV1/FVC < 70%. Bivariate correlation analysis was performed, using Spearman rho correlation coefficient (P < 0.05). Quality of life was assessed by SF-36. The mean age was 27.6 years (range: 12-42 yrs). 57.6% were female. OI type IV was the most common (46.7%), followed by OI type III (33.3%), OI type I (10%), OI type IX (6.67% each), and OI type VIII (3.33%). Pulmonary comorbidity was present in 40% of individuals, while 6.67% had a cardiac comorbidity. The correlation between scoliosis and pulmonary function was weak and not significant (R = -0.059, P = 0.747). Pulmonary function is not significantly correlated with scoliosis, supporting the hypothesis that decreased pulmonary function is intrinsic to OI and/or chest wall deformities, rather than secondary to scoliosis. 4.

Evaluation of Anterior-Posterior Spine Curvatures and Incidence of Sagittal Defects in Children and Adolescents Practicing Traditional Karate.

Background and Study Aim To evaluate anterior-posterior spine curvatures and incidence of sagittal defects in children and adolescents practicing traditional Karate. Material and Methods 152 people aged 6-16 yrs, mean age 10.5±3.03. The study group (SG), subjects attending traditional Karate classes for min one year, 60 minutes twice a week (76 people). The control group (CG) randomly selected on 1:1 basis to match SG. The anterior-posterior curvatures were measured with a gravitational inclinometer. Sauder's norms were used to assess postural defects. Body mass, height, and BMI were measured. Mann-Whitney U-test/Student's t-test for independent variables, χ2 test, and Cramer V test were used in statistical analysis. Results Significant differences were observed between the groups in lumbosacral inclination ALPHA1 p<0.001; karateka had significantly lower ALPHA 1 and greater thoracic inclination (GAMMA TH/L) p=0.23. In study group, lumbosacral angle flattening (ALPHA 2) (81.6%) was greater than in CG (56.6%). ALPHA 2 (43.4%) was more frequently within the norm in CG. Increased ALPHA 2 was reported only among SG (2.6%). Differences were statistically significant (χ2 (2) = 15.23 p<0.001) and of moderate power (Cramer V=0.31). Regarding thoracic kyphosis and lumbar lordosis, there were no statistically significant differences between the groups. Conclusions Traditional Karate affects pelvic tilt leading to posterior tilt; it correlates with somatic parameters: height, mass, and BMI in terms of spine curvatures. The size of the lumbar lordosis and thoracic kyphosis in karatekas is comparable to that of those not practicing sport. Frequent incidence of reduced pelvic tilt in karatekas requires implementing exercises activating anterior tilt during training session.

Anatomy of the pterygopalatine fossa: an innovative metrical assessment based on 3D segmentation on head CT-scan.

The pterygopalatine fossa is an important anatomical structure for several surgical and anaesthesiologic procedures; yet, very few data are available about its size. This study aims at providing a metrical assessment of pterygopalatine fossa through an innovative 3D segmentation procedure on head CT-scans. CT-scans from 100 patients (50 males and 50 females) aged between 18 and 85years were chosen for the study. Right and left pterygopalatine fossae were segmented through ITK-SNAP open source software. Height and volume were calculated on the acquired 3D models. In addition, anterior-posterior nasal spine distance, upper facial height (nasion-prosthion) and biorbital breadth (ectoconchion-ectoconchion) were measured as well. Statistically significant differences of height and volume according to sex and side were assessed through two-way ANOVA test: sexually dimorphic measurements were further assessed through one-way ANCOVA test using the three cranial measurements as covariates (p < 0.05). On average pterygopalatine fossa height was 24.1 ± 3.5mm in males, and 22.8 ± 3.4mm in females, whereas volume was 0.930 ± 0.181cm3 in males and 0.817 ± 0.157cm3 in females, with statistically significant differences according to sex (p < 0.05), but not to side (p > 0.05); interaction was negligible for both the measurements. ANCOVA test verified that sexual dimorphism of both measurements is independent from general cranial size (p < 0.05). The present study highlighted the sexual dimorphism of pterygopalatine fossa: results may improve the knowledge of this anatomical structure difficult to explore, but crucial in several fields of clinics and surgery.

Preoperative dual-energy X-ray absorptiometry and FRAX in patients with lumbar spinal stenosis

BackgroundOsteoporosis implies an increased risk of complications after orthopedic surgery. For the mostly elderly group of patients undergoing lumbar spinal stenosis surgery (LSS), it is important to include skeletal health evaluation in the preoperative planning. The aim of this study was to assess spine and femoral neck (FN) bone mineral density (BMD) in LSS patients and to evaluate whether the World Health Organization (WHO) fracture risk assessment tool (FRAX) can identify patients with reduced BMD levels in the spine.MethodsThe study involved 65 LSS patients and 53 patients with hip osteoarthritis (HOA) for comparison. BMD was measured with dual-energy X-ray absorptiometry (DXA) in the lumbar spine in three projections: anterior-posterior (AP), lateral and lateral-mid (the mid-portion of the vertebrae), and FN. The LSS patients filled out the FRAX questionnaire.ResultsIn the LSS group, 43% of the women and 8% of the men were classified as being osteoporotic/osteopenic by AP spine measurement. The corresponding proportions using the lateral spine T-score ≤ − 2.5 were 87% and 57%, respectively, and 82% and 53%, respectively, for the FN. The FN BMD T-score was significantly lower in the LSS group compared with the HOA group. The FRAX questionnaire identified 40% of the LSS patients with a moderate/high risk of sustaining an osteoporotic fracture within 10 years, with or without simultaneous FN BMD, while 71% of these patients were classified as being osteoporotic with DXA lateral spine measurement.ConclusionIt is common with osteoporosis/osteopenia in patients undergoing spine surgery, and the identification may influence the surgical treatment why the evaluation of BMD is important preoperatively. FRAX evaluation could not replace DXA measurement of the spine regarding the identification of osteoporosis patients in the preoperative planning phase.

Assessment of the risk of low bone mineral density in premenopausal Japanese female patients with systemic lupus erythematosus

BackgroundThe aim of this study was to assess the relationships between clinical parameters and bone mineral density (BMD) in Japanese female patients with systemic lupus erythematosus (SLE). MethodsA total of female 136 SLE patients without menopause were retrospectively assessed to identify associations between age, disease duration, body mass index (BMI), glucocorticoid usage and disease activity and BMD based on the treatment with or without bisphosphonate. There were 71 patients treated with bisphosphonate (bisphosphonate group) and 65 patients without (non-bisphosphonate group). We evaluated the impact of age, disease duration, BMI, serologic SLE markers, glucocorticoid use on BMD of the anterior-posterior (AP) and lateral lumbar spine, total hip and femoral neck using univariate and multivariate linear regression analyses of both bisphosphonate and non-bisphosphonate groups. ResultsMultivariate linear regression analyses showed that in non-bisphosphonate group disease duration was negatively associated with BMD of AP spine and femoral neck, whereas in bisphosphonate group these negative associations were not present. However, multivariate linear regression analyses showed a significant relationship between BMI and BMD of the AP spine, femoral neck and total hip, regardless of bisphosphonate treatment. ConclusionsBisphosphonate treatment eliminated the negative relationships between disease duration and the BMD of the spine and hip. AP spine and hip BMD in patients with SLE depend on BMI, regardless of bisphosphonate use. SLE serologic markers and glucocorticoid use were not negatively associated with generalized bone loss. SLE patients with low BMI have a high risk of generalized bone loss, and should be assessed and treated to prevent osteoporosis even before menopause.

Prevalence and risk factors of low bone mineral density in spondyloarthritis and prevalence of vertebral fractures

BackgroundInvestigate the prevalence and risk factors of low bone mineral density (BMD) in patients with axial spondyloarthritis as well as investigating the prevalence of vertebral fractures.MethodsPatients underwent BMD measurements with dual-energy X-ray absorptiometry (DXA) in the anterior-posterior lumbar spine, lateral spine and hip. We screened for vertebral fractures using vertebral fracture assessment, and then checked for syndesmophytes on the VFA images. Sociodemographic and clinical variables were collected.ResultsA total of 89 patients (41,6% female) took part in the study with a mean age of 44 ± 14 years and disease duration 10.2 ± 10.6 years. According to World Health Organization (WHO) criteria, 48,3% of patients displayed osteopenia and 6,7% osteoporosis. In the subgroup of women who underwent measurement at all sites including the lateral spine, the prevalence of osteopenia was 39.3% in the anterior-posterior spine, 32.1% in the lateral spine, and 64.3% with all sites together. VFA led to the diagnosis of at least one vertebral fracture in 6.2% of patients. On VFA, syndesmophytes were found in 24.3% of patients. The variables associated in multivariate analyses with low BMD in different measurement sites were low body mass index (BMI), a high physician’s global assessment score, a high Bath Ankylosing Spondylitis Functional Index (BASFI) score and female gender.ConclusionOur study found a high prevalence (around 50%) of low BMD in SpA. Conversely, the prevalence of osteoporosis (6.7% according to WHO criteria) and vertebral fractures (6.2%) was lower than generally reported in the literature. While lateral spine BMD measurement did little to improve the detection of osteopenia in women, the sample size was not large enough to enable us to draw definite conclusions.