Severe Osteoporotic Vertebral Fractures Research Articles

A Computed Tomography-based Radiomics Nomogram for Predicting Osteoporotic Vertebral Fractures: A Longitudinal Study.

Fractures are a serious consequence of osteoporosis in older adults. However, few longitudinal studies have shown the role of computed tomography (CT)-based radiomics in predicting osteoporotic fractures. We evaluated the performance of a CT radiomics-based model for osteoporotic vertebral fractures (OVFs) in a longitudinal study. A total of 7906 individuals without OVF older than 50 years, and who underwent CT scans between 2016 and 2019 were enrolled and followed up until 2021. Seventy-two cases of new OVF were identified. A total of 144 people without OVF during follow-up were selected as controls. Radiomics features were extracted from baseline CT images. CT values of trabecular bone, and area and density of erector spinae were determined. Cox regression analysis was used to identify the independent associated factors. The predictive performance of the nomogram was assessed using the receiver operating characteristic curve, calibration curve, and decision curve. CT value of vertebra (adjusted hazard ratio (aHR) = 2.04; 95% CI, 1.07-3.89), radiomics score (aHR = 6.56; 95% CI, 3.47-12.38), and area of erector spinae (aHR = 1.68; 95% CI, 1.02-2.78) were independently associated with OVF. Radscore was associated with severe OVF (aHR = 6.00; 95% CI, 2.78-12.93). The nomogram showed good discrimination with a C-index of 0.82 (95% CI, 0.77-0.87). The area under the curve of nomogram and radscore were both higher than osteoporosis + muscle area for 3-year and 4-year risk of fractures (P < .05). The decision curve also demonstrated that the radiomics nomogram was useful. Bone radiomics is associated with OVF, and the nomogram based on radiomics signature and muscle provides a tool for the prediction of OVF.

The 'armed concrete' approach: stent-screw-assisted internal fixation (SAIF) reconstructs and internally fixates the most severe osteoporotic vertebral fractures

BackgroundThe treatment of severe osteoporotic vertebral compression fractures (VCFs) with middle-column (MC) involvement, high fragmentation, large cleft and/or pedicular fracture is challenging. Minimally invasive 'stent-screw-assisted internal fixation' (SAIF) can reduce...

Is Kyphoplasty Necessary?

We describe four cases of delayed union in female patients with severe osteoporotic vertebral fractures, which were treated in a similar but less costly method to kyphoplasty. Due to domestic regulations, inflatable tamps for kyphoplasty are not available to every clinical orthopedists in Japan. In our clinical experience of four cases of delayed lumbar spine union between 2009 and 2010, we performed vertebroplasty using a reduction and spreading prod (Oyamada prod) for fracture reduction and a pediatric uromatic balloon (Medicon Co. Ltd.) to enlarge the pre-existing cavity. Our clinical results were comparable to those of kyphoplasty procedures performed in the USA. Our procedure could be used to overcome the shortage of medical supplies in developing countries or in countries such as Japan, which often prioritize financial concerns over providing optimal health care. Our method could serve as a useful compromise for moribund patients considering its cost efficiency.