Vertebral Cross-sectional Area Research Articles

Overloaded Vertebral Body Following Consecutive Three-Level Hybrid Surgery Comparing with Anterior Cervical Discectomy and Fusion.

Based on the varying number and relative positions of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF) procedures, three-segment hybrid surgery (HS) presents a diverse structural approach. Currently, the potential differential effects of HS with different segment combinations and surgical procedures on overloaded vertebral body (OVB) occurrence remain unexplored. The purpose of this retrospective study is to compare the clinical and radiological outcomes of HS and ACDF in treating cervical degenerative disc disease (CDDD), aiming to provide further insights into OVB. This study included patients with three-level CDDD who underwent ACDF or HS at our institution. Eligible patients were divided into three groups: Type I (one-level CDR and two-level ACDF), Type II (two-level CDR and one-level ACDF), and ACDF (three-level ACDF). For radiographic analysis, patients were further divided into the Replacement Segment Group and the Nonreplacement Segment Group based on the presence of replacement segments above and below the OVB. Clinical outcomes were evaluated using visual analog scale (VAS) scores for neck and arm pain, Japanese Orthopedic Association (JOA) scores, and neck disability index (NDI) scores. The cervical radiological parameters assessed included (1) vertebral cross-sectional area (CSA), (2) wedge angle (WA), (3) anterior vertebral height (AH), (4) posterior vertebral height (PH), and (5) Hounsfield unit (HU) values. Statistical methods included paired t-test, ANOVA test, and chi-square test. Independent samples t-test, Mann-Whitney U test, and Wilcoxon signed-rank test were used to compare the differences between two groups according to the results of normal distribution test. A total of 123 patients, evenly distributed among three groups, were included and were well matched in terms of demographic characteristics. The likelihood of vertebral body collapse (VBC) was notably higher in the ACDF group (41.5%) compared with the Type I (17.9%) and Type II (8.9%) groups (p < 0.01). Following surgery, both at 3 and 6 months, the ACDF group demonstrated higher VAS neck scores and NDI scores compared with the Type I and Type II groups (p < 0.01). Additionally, the WA and AH values of the upper and lower adjacent OVB were consistently lower in the ACDF group than in the Type I and Type II groups at 6 and 12 months and at the final follow-up (p < 0.01). Notably, in the Nonreplacement Segment Group, WA significantly decreased at 12 months postoperatively and at the final follow-up compared with the Replacement Segment Group (p < 0.01). Three levels of HS appear to reduce stress concentrations and alleviate morphological changes in OVB. The occurrence of more VBC patients with OVB was associated with the use of Zero-P or Zero-P VA implants.

7858 Increasing Severity of Growth Hormone Deficiency is Associated with Lower Vertebral Strength

Abstract Disclosure: R. Boutin: None. M. Haines: None. R. Shahid: None. C. Mark: None. C. Gill: None. M. Bredella: None. K.K. Miller: Other; Self; Pfizer, Inc. L.E. Dichtel: Consulting Fee; Self; Lumos Pharma. Grant Recipient; Self; Lumos Pharma, Perspectum Ltd. Research Investigator; Self; Recordati, Novo Nordisk. Stock Owner; Self; Marea Therapeutics. Other; Self; Third Rock Ventures. Objective: Growth hormone (GH) stimulates osteoblast differentiation, while insulin-like growth factor-1 (IGF-1) stimulates osteoblast proliferation and bone formation. Retrospective studies have demonstrated a 2-to-3-fold increased fracture risk in adults with GH deficiency (GHD) due to organic hypothalamic or pituitary disease, particularly at vertebral sites. Adults with overweight/obesity produce relatively less GH than lean individuals, and serum IGF-1 levels are associated positively with BMD in adults with obesity. Yet, no published studies have examined the relationship between degree of GHD across these groups and vertebral strength, an understudied measure of bone quality in part because HR-pQCT cannot image this skeletal site. We hypothesized that there would be an inverse association between degree of GHD and vertebral strength, independent of age and BMI. Methods: Cross-sectional study of 134 estrogen-replete (with regular menses or taking estrogen) women: 16 with GHD secondary to hypopituitarism (HP, severe GHD), 91 with obesity (OB) without a hypothalamic/pituitary disorder (relative GHD), and 37 lean controls (LC) without a hypothalamic/pituitary disorder (normal GH production). Peak-stimulated GH was assessed by GHRH-arginine testing. CT imaging at the L4 vertebra was performed to determine vertebral cross-sectional area and total integrated volumetric bone mineral density (Int.vBMD), from which estimates of vertebral strength were calculated. Results: Mean age [44±9 (mean±SD) (HP) vs. 35±7 (OB) vs. 30±7 (LC) y, p&amp;lt;0.005] and BMI [30±6 (HP) vs. 34±6 (OB) vs. 22±2 (LC) kg/m2, p&amp;lt;0.004] differed between all groups. As expected, peak-stimulated GH was highest in LC (28.3 ± 9.5 ng/mL) followed by OB (12.4 ± 8.9 ng/mL) and HP (2.4 ± 1.7 ng/mL), p&amp;lt;0.0001. IGF-1 Z-scores were higher in LC (0.0 ± 0.6) and OB (0.0 ± 0.7) vs. HP (-1.4 ± 0.7), p&amp;lt;0.0001. Int.vBMD and vertebral strength were higher in LC and OB vs. HP [Int.vBMD (g/cm3) LC 0.21±0.04 and OB 0.21±0.04 vs. HP 0.16±0.03, and vertebral strength (N) LC 4540±850 and 4743±91 vs. HP 3542±651, both p&amp;lt;0.0001], which remained significant when adjusted for age and BMI (p≤0.01). Peak-stimulated GH and IGF-1 Z-scores were positively associated with vertebral strength (GH R=0.33, p=0.003 and IGF-1 Z-score R=0.41, p&amp;lt;0.0001) and Int.vBMD (GH R=0.46, p&amp;lt;0.0001 and IGF-1 Z-score R=0.40, p&amp;lt;0.0001), which remained significant when adjusted for age and BMI. Among the subset of patients without organic pituitary disease (LC and OB only), IGF-1 Z-scores remained positively associated with vertebral strength (R=0.24, p&amp;lt;0.03) and Int.vBMD (R=0.22, p&amp;lt;0.05). Conclusions: These findings suggest that severe GHD is associated with impaired vertebral volumetric bone density and strength. Moreover, the relative GHD of obesity may contribute to lower vertebral bone density and strength in otherwise healthy adults with overweight/obesity. Presentation: 6/3/2024

Hounsfield units of vertebrae as a predictor of cervical deep paraspinal muscles atrophy and neck pain in degenerative cervical myelopathy.

This study investigated the correlation between Hounsfield units (HU) of the cervical vertebrae and atrophy of the cervical deep paraspinal muscles, namely the multifidus and semispinalis cervicis (SCer), in patients diagnosed with degenerative cervical myelopathy (DCM). The authors retrospectively analyzed data from 136 patients aged 50-79 years (81 males and 55 females) who underwent surgical intervention for DCM. HU measurements of the cancellous bone in the C4 vertebra were acquired through standardized techniques. The authors evaluated fatty infiltration (FI); analyzed functional and vertebral cross-sectional area (CSA) of the multifidus and SCer at the C4-5, C5-6, and C6-7 levels; and analyzed the presence of Modic changes (MCs) and the incidence of axial neck pain. Patients were categorized into group A (n = 56) with mean ± SD HU of 293.3 ± 15.6 and group B (n = 80) with mean ± SD HU of 389.5 ± 10.6. Both groups demonstrated significant improvements in postoperative clinical outcomes (p < 0.05); however, no statistically significant difference was observed (p > 0.05). Significant disparities in HU measurements and visual analog scale (VAS) scores for neck pain were observed between the groups (p < 0.05). The highest VAS score correlated with MCs-1 type (i.e., low signal on T1-weighted images and high signal on T2-weighted images). The functional CSA to vertebral CSA ratios of the multifidus and SCer in group A were markedly reduced compared to those of group B (p < 0.05). No significant difference was noted in functional CSA asymmetry between the groups for both muscles (p > 0.05). Lower HU measurements directly correlated with increased FI in the multifidus (p = 0.002) and SCer (p = 0.035). Furthermore, a strong positive association was found between the functional CSA to vertebral CSA ratio of the multifidus and HU values (p = 0.003), whereas HU measurements and VAS scores exhibited a negative correlation (p = 0.020). Among those patients older than 50 years with DCM, those with decreased HU values demonstrated elevated FI levels in the multifidus and SCer muscles. Moreover, these patients presented with pronounced muscle atrophy, which correlated with axial neck pain. A significant relationship was also identified between MCs and diminished HU values.

Analyzing lumbar vertebral shape and alignment in female patients with degenerative spondylolisthesis: Comparisons with spinal stenosis and risk factor exploration.

This study aimed to examine the vertebral body shape characteristics and spondylopelvic alignment in L4 degenerative spondylolisthesis (DS) as well as the risk factors for the development of DS. This cross-sectional study compared vertebral morphology and sagittal spinopelvic alignment in female patients with lumbar DS and lumbar spinal stenosis (LSS). The degree of lumbar lordosis (LL), pelvic incidence (PI), cross-sectional area (CSA), and vertebral body height ratio (ha/hp) of the lumbar spine were compared using full-length spine radiographs and computed tomography in 60 females with DS and in 60 women with LSS. No significant differences in age or body mass index were observed between the two groups; however, the DS and LSS groups significantly differed in PI (mean, 58.9±10.8 vs. 47.2±11.6, P < 0.001), L4 CSA (mean, 1,166.2 m2 vs. 1,242.0 m2, P = 0.002) and ha/hp (mean, 1.134 vs. 1.007, P < 0.001). The L4 ha/hp was significantly higher in the DS group than in the LSS group. Additionally, LL values were negatively correlated with vertebral L5 CSA in the DS group (r = -0.28, P < 0.05). The LSS and DS groups demonstrated positive correlations between LL and L2, L3, and L4 ha/hp (r = 0.331, 0.267, and 0.317; P < 0.01, < 0.05, and < 0.05, respectively) and between LL and L4 and L5 ha/hp (r = 0.333, 0.331; P < 0.01, respectively). Multivariate regression analyses revealed that PI and ha/hp ratio may be independent predictors of DS development. The DS group had significantly larger LL, PI, and L4 ha/hp and smaller L4 CSA than the LSS group. The lumbar vertebral body shape and sagittal spinopelvic alignment in females might be independent predictors of DS development.

Developmental cervical spinal canal size: population reference range.

The developmental size of the cervical spinal canal varies considerably. Neural compression and injury are more likely with a developmentally small spinal canal. This study was designed to develop a population reference range for developmental cervical spinal canal size for the Hong Kong population. Prospective study of 522 ambulatory patients (256 males, 266 females, mean age 55±18 years; range, 20-89 years) who underwent computed tomography (CT) neck examinations. Using a manually operated segmentation program, spinal canal, and vertebral body cross-sectional area (CSA), anteroposterior (AP) sagittal diameter, and width were measured at each level from C3-C7. Patient height and weight were measured. Considerable variation in spinal canal size existed with, for example, a 164-168% variation exists for males and females between the largest and smallest spinal canal CSA at C5. All spinal canal measurements increased slightly with height (r=0.25-0.36, P<0.001), while vertebral body AP sagittal diameter increased with age (r=0.48-0.51, P<0.001). All spinal canal measurements were larger (<0.0001) in males. Although spinal canal CSA was larger in males (at C5, males 276.0±41.5 mm2; females 252.6±38.4 mm2), relative to vertebral body CSA, spinal canal CSA was larger in females. Arbitrary population thresholds indicating the smallest 25% spinal canal CSA and AP sagittal diameter as well as other parameters were defined. There is a large variation in developmental cervical spinal canal size within the Hong Kong population. A reference range of developmental spinal canal size was developed which will enable an objective assessment of an individual's cervical spinal canal size relative to the wider population.

Overloaded vertebral body: a unique radiographic phenomenon following multilevel anterior cervical discectomy and fusion

PurposeBecause previous studies have not focused on postoperative cervical collapse, the purpose of the present study was to introduce the overloaded vertebral body (OVB) phenomenon following multilevel zero-profile anterior cervical discectomy and fusion (ACDF) as well as to investigate its effects on radiographic outcomes.MethodsWe conducted a retrospective study involving patients who underwent ACDF. A total of 55 patients were included in the analysis, including 110 OVB and 110 non-OVB. The evaluated vertebral parameters included the vertebral cross-sectional area (CSA), wedge angle (WA), vertebral height [anterior (AH) and posterior (PH)] and anterior–posterior vertebral diameter [upper (UD) and lower (LD)].ResultsThe CSA and WA were significantly lower in the OVB group than in the non-OVB group at 3, 6, and 12 months after surgery as well as at the final follow-up (p < 0.01). The AH of the OVB group was significantly lower at 3, 6, and 12 months after surgery as well as at the final follow-up compared to 1 week after surgery (p < 0.01).ConclusionsOVB, a new phenomenon following multilevel ACDF, is defined as the cervical vertebral body located in the middle of the surgical segments in multilevel anterior cervical spine surgery. Statistical analysis of vertebral parameters, including CSA, WA, AH, PH, UD, and LD, showed that OVB occurs mainly at the anterior edge of the vertebra and that its largest radiographic manifestation is the loss of height at the anterior edge of the vertebra in the early postoperative period.

Association between vertebral cross-sectional area and lumbar disc displacement – a population-based study

PurposeVertebral dimensions may constitute a potential risk factor for degenerative changes in the spine. Previous studies have found a positive association between vertebral height and both type 2 Modic changes and intervertebral disc height loss. Also, vertebral endplate size has been associated with disc degeneration. However, only a few studies have investigated the association between vertebral dimensions and lumbar disc displacement (LDD). This study aimed to investigate the association between vertebral cross-sectional area (CSA) and LDD among the general middle-aged Finnish population. We hypothesized that larger vertebral CSA is associated with LDD.Materials and methodsThe study was conducted by using data from the Northern Finland Birth Cohort 1966 (NFBC1966). At the age of 46, a subpopulation of NFBC1966 underwent clinical examinations including magnetic resonance imaging (MRI) (n = 1249). MRI scans were used to measure L4 CSA and evaluate the presence of LDD (bulge, protrusion, and extrusion/sequestration) in the adjacent discs. The association between L4 CSA and LDD was analysed using logistic regression, with adjustment for sex, education, body mass index, leisure-time physical activity, smoking, diet, and L4 height.ResultsLarger L4 CSA was associated with LDD; an increase of 1 cm2 in vertebral CSA elevated the odds of LDD relative to no LDD by 10% (adjusted odds ratio 1.10, 95% CI 1.01–1.19). The association was similar among either sex.ConclusionsLarger L4 vertebral CSA was associated with LDD in our study sample. Even though smaller vertebral size exposes our vertebrae to osteoporotic fractures, it simultaneously seems to protect us from LDD.

Cervical Vertebrae Skeletal Muscle Auto Segmentation for Sarcopenia Analysis Using Pre-Therapy CT in Head and Neck Cancer Patients

<h3>Purpose/Objective(s)</h3> Sarcopenia is a well-known prognostic factor in head and neck cancer (HNC) patients. Sarcopenia status in HNC patients can be determined using the skeletal muscle (SM) index (SMI) as calculated from the cross-sectional area (CSA) of C3 cervical vertebrae musculature. However, current approaches to generate the C3 SM segmentations rely on human judgment which is time consuming and prone to inter-observer variability. We hypothesize that deep learning (DL) can be used to develop a fully automated approach to segment SM at the C3 vertebral level for SMI calculations which can be used for subsequent body composition and sarcopenia assessment. <h3>Materials/Methods</h3> 390 HNC patients from a public database with corresponding contrast-enhanced computed tomography (CT) scans were utilized. Patients were split into training (n=300) and testing (n=90) sets. Ground truth (GT) single-slice SM segmentations at the C3 vertebral level were manually generated. A multi-stage DL pipeline was developed using the MONAI package, where a 3D ResUnet model auto-segmented the C3 section, the middle slice of the segmented C3 section was auto-selected, and a 2D ResUnet model auto-segmented the auto-selected slice. Both the 3D and 2D approaches trained five sub-models (5-fold cross-validation) and combined sub-model predictions on the test set using majority vote ensembling. Model performance was determined using the Dice similarity coefficient (DSC). Additionally, we quantified the absolute difference between the slice locations of the C3 mid-section predicted by the 3D model and the single-slice CT GT image. Furthermore, we compared the GT C3 vertebral level SM CSA and the corresponding SMI to the 2D model predictions. Finally, using these SMI values coupled to previously established sarcopenia stratification cutoffs, we performed a Kaplan Meier analysis on the entire dataset to determine associations to overall survival. <h3>Results</h3> Mean test set DSC of the 3D and 2D models were 0.96 and 0.95, respectively. The mid-slices of the 3D model segmentations were within 2 mm distance of the GT slices for 78% of the test patients. The CSA derived from the 2D model predictions using the auto-selected slice from the 3D model and corresponding SMI values were highly correlated to the CSA (r=0.98) and SMI (r=0.96) derived from the GT segmentations. Kaplan Meier analysis revealed that the SMI values derived from auto-segmented SM could stratify patients for overall survival in males (log-rank p < 0.05) but not females (log-rank p > 0.05), with results that were consistent with SMI values derived from the GT segmentations. <h3>Conclusion</h3> Using open-source toolkits and public datasets, we developed a high-performance multi-stage DL auto-segmentation for SM at the C3 vertebrae. This work is a vital first step towards fully automated workflows for sarcopenia-related clinical decision making.

Increased vertebral body area, disc and facet joint degeneration throughout the lumbar spine in patients with lumbosacral transitional vertebrae.

Lumbosacral transitional vertebrae (LSTV), developmental spinal canal stenosis, lumbar disc and facet joint degeneration are all common lumbar spine conditions. This study explores the relationship between these entities. Five hundred and five patients (254 females, 251 males), mean age 57 ± 13 years, who underwent abdominopelvic CT examinations were studied. Vertebral body cross-sectional area (CSA), spinal canal CSA, width and depth were measured from L1 to L5. The presence of LSTV was documented and the severity of disc/facet joint degeneration graded. LSTV was present in 155 (31%) of 505 patients, being twice as common in males than in females. After controlling for age, height and weight, vertebral body CSAs from L1 to L5 in male LSTV patients were, on average, 9.8% larger than those in male non-LSTV patients (p < 0.0001 for all) while vertebral body areas at L3 and L4 were 4.5% larger in female LSTV patients than in non-LSTV female patients. Disc degeneration from L2/3 to L5/S1 and facet joint degeneration from L2/3 to L4/5 were more severe in LSTV patients. LSTV Castellvi Type II patients appear to be most prone to disc and facet degeneration. LSTV patients, and particularly male patients, have an increased vertebral body CSA compared to non-LSTV patients throughout the lumbar spine. LSTV patients also have more severe disc and facet joint degeneration. The increase in vertebral body area may be contributing to the increased lumbar and facet joint degeneration seen in LSTV patients. • LSTV patients have increased vertebral body cross-sectional area throughout their lumbar spine compared to non-LSTV patients. This vertebral body area increase was more pronounced in male patients and also apparent in younger patients with LSTV. • LSTV patients have increased disc and facet joint degeneration affecting most of the lumbar spine than non-LSTV patients. • Increased vertebral body area may contribute to the increased lumbar disc and facet joint degeneration seen in LSTV patients.

Assessing Fatty Infiltration of Paraspinal Muscles in Patients With Lumbar Spinal Stenosis: Goutallier Classification and Quantitative MRI Measurements.

Objective: Fatty infiltration of paraspinal muscle is associated with spinal disorders. It can be assessed qualitatively (i.e., Goutallier classification) and quantitatively using image processing software. The aims of this study were to compare paraspinal muscle fatty infiltration as assessed using the Goutallier classification vs. quantitative magnetic resonance images (MRI) measurements and to investigate the association between anthropometric parameters and paraspinal muscle morphology and fatty infiltration in patients with symptomatic lumbar spinal stenosis (LSS).Methods: Patients affected by symptomatic LSS scheduled for surgery with available MRI of the lumbar spine were included in this retrospective cross-sectional study. Fatty infiltration at each lumbar level was rated qualitatively according to the Goutallier classification and quantified based on the cross-sectional area (CSA) of the paraspinal muscle, of its lean fraction (LeanCSA), and the ratio between LeanCSA and CSA and the CSA relative to the CSA of vertebral body (RCSA). Considering the muscle as a single unit, overall fatty infiltration according to Goutallier, overall CSA, LeanCSA, LeanCSA/CSA, and RCSA were computed as averages (aGoutallier, aCSA, aLeanCSA, aLeanCSA/aCSA, and aRCSA). Associations among parameters were assessed using Spearman's respective Pearson's correlation coefficients.Results: Eighteen patients, with a mean age of 71.3 years, were included. aGoutallier correlated strongly with aLeanCSA and aLeanCSA/aCSA (R = −0.673 and R = −0.754, both P < 0.001). There was a very strong correlation between values of the left and right sides for CSA (R = 0.956, P < 0.001), LeanCSA (R = 0.900, P < 0.001), and LeanCSA/CSA (R = 0.827, P < 0.001) at all levels. Among all anthropometric measurements, paraspinal muscle CSA correlated the most with height (left: R = 0.737, P < 0.001; right: R = 0.700, P < 0.001), while there was a moderate correlation between vertebral body CSA and paraspinal muscle CSA (left: R = 0.448, P < 0.001; right: R = 0.454, P < 0.001). Paraspinal muscle CSA correlated moderately with body mass index (BMI; left: R = 0.423, P < 0.001; right: R = 0.436, P < 0.001), and there was no significant correlation between aLeanCSA or aLeanCSA/CSA and BMI.Conclusions: The Goutallier classification is a reliable yet efficient tool for assessing fatty infiltration of paraspinal muscles in patients with symptomatic LSS. We suggest taking body height as a reference for normalization in future studies assessing paraspinal muscle atrophy and fatty infiltration.

The association between physical activity and vertebral dimension change in early adulthood – The Northern Finland Birth Cohort 1986 study

Small vertebral size is a well-known risk factor for vertebral fractures. To help understanding the factors behind vertebral size, we aimed to investigate whether physical activity and participation in high-impact exercise are associated with the growth rate of the vertebral cross-sectional area (CSA) among young adults. To conduct our study, we utilized the Northern Finland Birth Cohort 1986 as our study population (n = 375). Questionnaire data about physical activity was obtained at 16, 18 and 19 years of age and lumbar magnetic resonance imaging scans at two timepoints, 20 and 30 years of age. We used generalized estimating equation (GEE) models to conduct the analyses. We did not find any statistically significant associations between vertebral CSA, physical activity, and high-impact exercise in our study sample. We conclude that neither physical activity nor high-impact sports seem to influence the change in vertebral CSA among young adults.

Association Between Liver Fat and Bone Density is Confounded by General and Visceral Adiposity in a Community-Based Cohort.

Nonalcoholic fatty liver disease (NAFLD) is associated with low bone mineral density (BMD); however, it is not known whether early-stage NAFLD may be associated with BMD after accounting for BMI or visceral adipose tissue (VAT). This was a cross-sectional study of 3,462 Framingham Heart Study participants who underwent computed tomographic measurement of liver fat, VAT volume, volumetric spine BMD, vertebral cross-sectional area (CSA), and vertebral compressive strength. This study excluded heavy alcohol consumers. Multivariable linear regression models were used to assess the association between NAFLD and volumetric BMD, CSA, and vertebral compressive strength after accounting for covariates, including BMI or VAT. A total of 2,253 participants (mean age, 51.2 [SD 10.7] years; 51.1% women) were included. In multivariable-adjusted models, positive associations between NAFLD and integral BMD, trabecular BMD, and vertebral compressive strength were observed. However, results were attenuated and no longer significant after additionally adjusting for BMI or VAT. NAFLD was observed to be weakly associated with a lower vertebral CSA in adjusted models. In a community-based cohort, the associations between NAFLD and BMD and vertebral strength were confounded by BMI and VAT. However, NAFLD was associated with a reduced vertebral CSA in adjusted models.

Assessing fatty infiltration of paraspinal muscles in patients with lumbar spinal stenosis: Goutallier classification and quantitative MRI measurements

Objective: Fatty infiltration of paraspinal muscle is associated with spinal disorders. It can be assessed qualitatively (i.e., Goutallier classification) and quantitatively using image processing software. The aims of this study were to compare paraspinal muscle fatty infiltration as assessed using the Goutallier classification vs. quantitative magnetic resonance images (MRI) measurements and to investigate the association between anthropometric parameters and paraspinal muscle morphology and fatty infiltration in patients with symptomatic lumbar spinal stenosis (LSS). Methods: Patients affected by symptomatic LSS scheduled for surgery with available MRI of the lumbar spine were included in this retrospective cross-sectional study. Fatty infiltration at each lumbar level was rated qualitatively according to the Goutallier classification and quantified based on the cross-sectional area (CSA) of the paraspinal muscle, of its lean fraction (LeanCSA), and the ratio between LeanCSA and CSA and the CSA relative to the CSA of vertebral body (RCSA). Considering the muscle as a single unit, overall fatty infiltration according to Goutallier, overall CSA, LeanCSA, LeanCSA/CSA, and RCSA were computed as averages (aGoutallier, aCSA, aLeanCSA, aLeanCSA/aCSA, and aRCSA). Associations among parameters were assessed using Spearman's respective Pearson's correlation coefficients. Results: Eighteen patients, with a mean age of 71.3 years, were included. aGoutallier correlated strongly with aLeanCSA and aLeanCSA/aCSA (R = -0.673 and R = -0.754, both P < 0.001). There was a very strong correlation between values of the left and right sides for CSA (R = 0.956, P < 0.001), LeanCSA (R = 0.900, P < 0.001), and LeanCSA/CSA (R = 0.827, P < 0.001) at all levels. Among all anthropometric measurements, paraspinal muscle CSA correlated the most with height (left: R = 0.737, P < 0.001; right: R = 0.700, P < 0.001), while there was a moderate correlation between vertebral body CSA and paraspinal muscle CSA (left: R = 0.448, P < 0.001; right: R = 0.454, P < 0.001). Paraspinal muscle CSA correlated moderately with body mass index (BMI; left: R = 0.423, P < 0.001; right: R = 0.436, P < 0.001), and there was no significant correlation between aLeanCSA or aLeanCSA/CSA and BMI. Conclusions: The Goutallier classification is a reliable yet efficient tool for assessing fatty infiltration of paraspinal muscles in patients with symptomatic LSS. We suggest taking body height as a reference for normalization in future studies assessing paraspinal muscle atrophy and fatty infiltration.

Association Between Vertebral Dimensions and Lumbar Modic Changes.

Population-based birth cohort study. The aim of this study was to evaluate the relationship between vertebral dimensions and lumbar MC. Low back pain (LBP) has become the leading cause of disability worldwide. Modic changes (MC) of the lumbar spine are one potential LBP-associated etiological factor. Mechanical stress is considered to play a key role in the development of MC through damage to endplates. There is speculation that vertebral dimensions play a role in some degenerative changes in the spine. Previous studies have also shown a positive association between moderate-to-vigorous physical activity (MVPA) and both vertebral dimensions and MC. In this study, we aimed to evaluate the relationship between vertebral dimensions and MC. The study population consisted of 1221 participants from the Northern Finland Birth Cohort 1966 who underwent lumbar magnetic resonance imaging (MRI) and physical activity measurements at the age of 46-48. The presence of Type 1 (MC1) and Type 2 (MC2) MC and the height, axial cross-sectional area (CSA), and volume of the L4 vertebra were determined from MRI scans. MVPA (≥3.5 metabolic equivalents) was measured by a wrist-worn accelerometer. We analyzed the association between lumbar MC and vertebral height, CSA, and volume using logistic regression models before and after adjustment for sex, height, weight, smoking, education level, and MVPA. Vertebral height was positively associated with the presence of MC2 (odds ratio [OR] 3.51; 95% confidence interval [CI] 1.43-8.65), whereas vertebral CSA was not associated with the presence of lumbar MC. Vertebral volume was positively associated with the presence of any MC (OR 1.04; 95% CI 1.00-1.07), but the association did not persist when analyzing MC1 and MC2 separately. Vertebral height was associated with the presence of MC2. Further studies are needed to clarify the role of vertebral dimensions as independent risk factors for MC.Level of Evidence: 3.

Baseline anthropometric indices predict change in vertebral size in early adulthood - A 10-year follow-up MRI study.

The vertebral cross-sectional area (CSA) has an independent effect on vertebral strength. Recent evidence has shown that vertebral dimensions significantly increase in the third decade of life, and that lifestyle factors such as body size and composition are clearly associated with vertebral CSA. This study aimed to test the hypothesis that general anthropometric traits (stature, total body mass, lean body mass, fat mass, body mass index, waist circumference), each objectively measured at baseline, predict the change in vertebral CSA over the subsequent decade. A representative sample of young Northern Finnish adults was used (n=371) with repeated magnetic resonance imaging (MRI) scans from ~20 and ~30years (baseline and follow-up, respectively). Vertebral CSA was measured from the MRI scans with high reliability and low measurement error. The statistical analysis was performed using linear regression models adjusted for sex and exact length of MRI interval. According to the regression models, in descending order of effect size, lean body mass (standardized beta coefficient 0.243 [95% confidence interval 0.065-0.420]), total body mass (0.158 [0.043-0.273]), body mass index (0.125 [0.026-0.224]), waist circumference (0.119 [0.010-0.228]), and fat mass (0.104 [0.004-0.205]) were positively and significantly associated with CSA gain over the follow-up, whereas stature (0.079 [-0.066-0.224]) was not associated with CSA change. The results of this study suggest that anthropometric indices may be used for estimating subsequent change in vertebral size. In particular, greater lean body mass seems to be beneficial for vertebral size and thus potentially also for vertebral strength. Future studies should aim to replicate these associations in a dataset with longitudinal anthropometric trajectories and identify the potential common factors that influence both anthropometric traits and vertebral CSA gain.

Lumbar lordosis reduction and disc bulge may correlate with multifidus muscle fatty infiltration in patients with single-segment degenerative lumbar spinal stenosis

ObjectivesTo investigate the correlation between fatty infiltration in the multifidus muscle related to the involved nerve root and structural parameters associated with stenosis in patients with degenerative lumbar spinal stenosis (DLSS). Patients and methodsSixty-four patients with single-segment DLSS at L4-5 were retrospectively enrolled. The fatty infiltration rate (FIR) of the multifidus muscle at L5-S1, lumbar lordosis and the cross-sectional area (CSA) of the structural parameters at L4-5, such as dural sac, disc bulge, ligamentum flava and vertebral body of L5 were measured on magnetic resonance images using ImageJ software. All enrolled patients were divided into an FIR < 25 % group and an FIR ≥ 25 % group according to the FIR of the multifidus muscle at L5-S1. The propensity scores matching and adjustment of potential covariates were performed to reduce the confounding bias between the two groups. ResultsLumbar lordosis in the FIR ≥ 25 % group was significantly lower than that in the FIR＜25 % group in both cohorts. The mean differences in lumbar lordosis of 14.16 degrees between the two groups in the complete cohort and of 14.23 degrees in the matched cohort remained significant after adjustment. The disc bulge CSA/ vertebral body CSA in the FIR ≥ 25 % group was greater than that in the FIR＜25 % group in both cohorts. The mean differences in the disc bulge CSA/ vertebral body CSA between the two groups of 0.67 in the complete cohort and 0.96 in the matched cohort were statistically significant after adjustment. There was no significant difference in the dural sac CSA/ vertebral body CSA and ligamentum flava CSA/ vertebral body CSA between the two groups in either cohort regardless of adjustment. Logistic regression analysis for FIR ≥ 25 % in the multifidus muscle at L5-S1 exhibited that the disc bulge CSA/ vertebral body CSA were independent risk factors with odds ratio (OR) of 8.52, while lumbar lordosis were independent protective factors (OR = 0.72). ConclusionsThe disc bulge at the stenosis segment and lumbar lordosis reduction may be correlated with fatty infiltration in the multifidus muscles at L5-S1 in patients with L4-5 single-segment DLSS.

Eating Behavior Traits, Weight Loss Attempts, and Vertebral Dimensions Among the General Northern Finnish Population.

A population-based birth cohort study. To evaluate the associations of eating behavior traits and weight loss attempts with vertebral size among the general Northern Finnish population. Vertebral fragility fractures are a typical manifestation of osteoporosis, and small vertebral dimensions are a well-established risk factor for vertebral fracturing. Previous studies have associated cognitive eating restraint and diet-induced weight loss with deteriorated bone quality at various skeletal sites, but data on vertebral geometry are lacking. This study of 1338 middle-aged Northern Finns evaluated the associations of eating behavior traits (flexible and rigid cognitive restraint of eating, uncontrolled eating, emotional eating; assessed by the Three-Factor Eating Questionnaire-18) and weight loss attempts (assessed by a separate questionnaire item) with magnetic resonance imaging-derived vertebral cross-sectional area (CSA). Sex-stratified linear regression models were used to analyze the data, taking body mass index, leisure-time physical activity, general diet, smoking, and socioeconomic status as potential confounders. Women with rigid or rigid-and-flexible cognitive eating restraints had 3.2% to 3.4% smaller vertebral CSA than those with no cognitive restraint (P ≤ 0.05). Similarly, the women who reported multiple weight loss attempts in adulthood and midlife had 3.5% smaller vertebral size than those who did not (P = 0.03). Other consistent findings were not obtained from either sex. Rigid cognitive eating restraint and multiple weight loss attempts predict small vertebral size and thus decreased spinal health among middle-aged women, but not among men. Future longitudinal studies should confirm these findings. 3.

Morphologic Characteristics of the Deep Cervical Paraspinal Muscles in Patients with Single-Level Cervical Spondylotic Myelopathy

This study aimed to compare morphologic changes of deep paraspinal muscles at C4-7 in patients with C5-6 single-level cervical spondylotic myelopathy (CSM), and to evaluate the relationship between morphologic changes and the level of spinal cord compression. The study included 15 patients with C5-6 single-level CSM and 15 age- and sex-matched healthy subjects. Cross-sectional area (CSA) and functional CSA of the bilateral longus capitis (LCap), longus colli (LC), multifidus (MF), semispinalis cervicis (SSC), semispinalis capitis, splenius capitis, and splenius cervicis were measured on preoperative magnetic resonance images at C4-7, and calculated as ratios with respect to the corresponding vertebral body CSA. The mean maximum spinal cord compression was 22.30% in the CSM group. At the cranial level (C4-5), the CSM group had more fat infiltration in the MF and SSC (P < 0.05). At the spinal cord compression segment and caudal adjacent segment (C5-6 and C6-7), the degree of fat infiltration of all paravertebral muscles was aggravated, accompanied by atrophy of LCap, LC, and MF (P < 0.05). Compared between different levels, fat infiltration in the MF at C5-6 was greater than adjacent levels. In patients with C5-6 single-level CSM, fat infiltration and atrophy of deep paraspinal muscles, especially the Lcap, LC, and MF, mainly occurred in the level of spinal cord compression and caudal adjacent level. In the cranial adjacent segment, the degree of MF and SSC fat infiltration in patients with CSM was also aggravated. This may suggest that multiple mechanisms are involved in paraspinal muscles degeneration in CSM.

Body mass estimation from dimensions of the fourth lumbar vertebra in middle-aged Finns.

Although body mass is not a stable trait over the lifespan, information regarding body size assists the forensic identification of unknown individuals. In this study, we aimed to study the potential of using the fourth lumbar vertebra (L4) for body mass estimation among contemporary Finns. Our sample comprised 1158 individuals from the Northern Finland Birth Cohort 1966 who had undergone measurements of body mass at age 31 and 46 and lumbar magnetic resonance imaging (MRI) at age 46. MRI scans were used to measure the maximum and minimum widths, depths, and heights of the L4 body. Their means and sum were calculated together with vertebral cross-sectional area (CSA) and volume. Ordinary least squares (OLS) and reduced major axis (RMA) regression was used to produce equations for body mass among the full sample (n = 1158) and among normal-weight individuals (n = 420). In our data, body mass was associated with all the L4 size parameters (R = 0.093-0.582, p ≤ 0.019 among the full sample; R = 0.243-0.696, p ≤ 0.002 among the normal-weight sample). RMA regression models seemed to fit the data better than OLS, with vertebral CSA having the highest predictive value in body mass estimation. In the full sample, the lowest standard errors were 6.1% (95% prediction interval ±9.6 kg) and 7.1% (±9.1 kg) among men and women, respectively. In the normal-weight sample, the lowest errors were 4.9% (±6.9 kg) and 4.7% (±5.7 kg) among men and women, respectively. Our results indicate that L4 dimensions are potentially useful in body mass estimation, especially in cases with only the axial skeleton available.

The Association of Body Size, Shape and Composition with Vertebral Size in Midlife \u2013 The Northern Finland Birth Cohort 1966 Study

Small vertebral size increases the risk of osteoporotic vertebral fractures. Obese individuals have larger vertebral size and potentially lower fracture risk than lean individuals, but scarce data exist on the association between vertebral size and anthropometric measures beyond height, weight, and body mass index (BMI). Here, we evaluated several anthropometric measures (height, weight, BMI, waist circumference, hip circumference, waist-to-hip ratio [WHR], waist-to-height ratio [WHtR], fat mass [FM], lean body mass [LBM], percentage FM [%FM], percentage LBM [%LBM]) as predictors of vertebral cross-sectional area (CSA). We used a representative sample from the Northern Finland Birth Cohort 1966 (n = 1087), with anthropometric measurements from the ages of 31 and 46, bioimpedance analysis from the age of 46, and lumbar magnetic resonance imaging from the age of 46 years. In our data, height and LBM correlated most strongly with vertebral CSA among both sexes (0.469 ≤ r ≤ 0.514), while WHR, WHtR, %FM, and %LBM had the weakest correlations with vertebral CSA (|r| ≤ 0.114). We conclude that height and LBM have the highest, yet only moderate correlations with vertebral size. High absolute LBM, rather than FM or abdominal mass accumulation, correlates with large vertebral size and thus potentially also with lower osteoporotic vertebral fracture risk.