Effect of lumbosacral transitional vertebra on developmental alterations of the hip: a quantitative investigation of the lumbo-pelvic-hip complex via whole-body computed tomography
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PROVIDER: S-EPMC11250340 | biostudies-literature | 2024 Jun
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe variation at the lumbosacral junction certainly results in occult alignment changes in the lumbo-pelvic complexity (LPC). This retrospective case-control study aims to investigate the influences of lumbosacral transitional vertebrae (LSTV) on sagittal lumbo-pelvic balance assessment and provide some recommendations for preoperative imaging evaluation.MethodsBased on whole-body computed tomography (CT) images, a total of 210 individuals with complete segmentation anomalies of LSTV were included and divided into 23 presacral vertebrae (PSV) (sacralization, n=102), 25 PSV (lumbarization, n=108). The control group with 24 PSV (normal, n=100) was matched by age and gender. Sagittal lumbo-pelvic parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), sacral table angle (STA), sacral kyphosis (SK), and pelvic radius (PR) were measured at the ontogenetical S1 (Ontog S1) level and the morphological S1 (Morph S1), respectively. These parameters were compared using t-test, Kruskal-Wallis H test and post hoc test. Spearman's rank correlation coefficient and linear regression were used to investigate the association of lumbo-pelvic parameters with LSTV types and measurement levels.ResultsAll the parameters at the Ontog S1 differed significantly from those at the Morph S1 (all P<0.001). At the Ontog S1 level, PI, PT, SS, and LL were negatively correlated with vertebrae counts; SK and PR were positively correlated with vertebrae counts (all P<0.001). Instead, reverse results were obtained at the Morph S1 level. The measurement level and vertebrae counts were independent influence factors for the measurement of PI, PT, SS, SK, and PR (all P<0.05). Compared with the measured values of the matched controls, the variability of most lumbo-pelvic parameters (PI, SS, LL, STA, SK, PR values of 25 PSV subgroup, and PI, PT, SS, LL, STA values of 23 PSV subgroup) at the Morph S1 level were significantly smaller than that at the Ontog S1. The measurements of PT, SS, LL, and PR were less influenced by the measurement level and vertebrae counts than those of PI and SK.ConclusionsMorph S1 is more recommended for the measurements of most lumbo-pelvic parameters in patients with LSTV. The parameters (PT, SS, LL, STA, PR) are shown more stable and recommended to help reduce the effects caused by LSTV.
| S-EPMC10722060 | biostudies-literature
Project description:Previous studies on joint kinetics during track and field block starts have been limited to lower-limb sagittal kinetics; however, we hypothesised that lumbopelvic extensors, lateral flexors, and hip abductors also act as substantial energy generators. The present study aimed to examine the three-dimensional lumbo-pelvic-hip kinetics to better understand the generation of mechanical energy during a block start. 3D kinematic and force data during block starts of 10 m maximal sprinting in 12 male sprinters (personal best in a 100 m sprint, 10.78 ± 0.19 s [range, 10.43-11.01 s]) were captured using a motion capture system and force platform. The three-dimensional lumbo-pelvic-hip kinetics were calculated. The peak lumbosacral extension torque (3.64 ± 0.39 Nm/kg) was significantly larger than any other lower-limb and lumbosacral torques (<3.0 Nm/kg). It was suggested that large lumbopelvic extension torques are needed during the block start to anchor the pelvis by cancelling out both hip extension torques acting on the pelvis, leading to hip extensor-induced thigh sagittal rotations rather than pelvic posterior tilt. During the double-stance phase, the lumbosacral extensors generated mechanical energy (0.35 ± 0.16 J/kg, 14 ± 4% of the sum of lumbosacral and lower-limb net joint work). During the single-stance phase, the sum of the net mechanical work by lumbosacral lateral flexors and front hip abductors was 0.35 ± 0.14 J/kg, which comprised 9 ± 3% of the sum of the net joint work. The results lead to the speculation of the importance of strengthening not only the leg extensors, but also the lumbopelvic extensors, lateral flexors, and hip abductors for block starts. Further training studies to verify this speculation will improve training strategies for the track and field block start performance.
| S-EPMC7067397 | biostudies-literature
Project description:BackgroundOsteoporotic vertebral compression fractures (OVCFs) are the most common type of fragility fracture. Distinguishing between OVCFs and other types of vertebra diseases, such as old fractures (OFs), Schmorl's node (SN), Kummell's disease (KD), and previous surgery (PS), is critical for subsequent surgery and treatment. Combining with advanced deep learning (DL) technologies, this study plans to develop a DL-driven diagnostic system for diagnosing multi-type vertebra diseases.MethodsWe established a large-scale dataset based on the computed tomography (CT) images of 1,051 patients with OVCFs from Luhe Hospital and used data of 46 patients from Xuanwu Hospital as alternative hospital validation dataset. Each patient underwent one examination. The dataset contained 11,417 CT slices and 19,718 manually annotated vertebrae with diseases. A two-stage DL-based system was developed to diagnose five vertebra diseases. The proposed system consisted of a vertebra detection module (VDModule) and a vertebra classification module (VCModule).ResultsThe training and testing dataset for the VDModule consisted of 9,135 and 3,212 vertebrae, respectively. The VDModule using the ResNet18-based Faster region-based convolutional neural network (R-CNN) model achieved an area under the curve (AUC), false-positive (FP) rate, and false-negative (FN) rate of 0.982, 1.52%, and 1.33%, respectively, in the testing dataset. The training dataset for VCModule consisted of 14,584 and 47,604 diseased and normal vertebrae, respectively. The testing dataset consisted of 4,489 and 15,122 diseased and normal vertebrae, respectively. The ResNet50-based VCModule achieved an average sensitivity and specificity of 0.919 and 0.995, respectively, in diagnosing four kinds of vertebra diseases except for SN in the testing dataset. In the alternative hospital validation dataset, the ResNet50-based VCModule achieved an average sensitivity and specificity of 0.891 and 0.989, respectively, in diagnosing four kinds of vertebra diseases except for SN.ConclusionsOur proposed DL system can accurately diagnose four vertebra diseases and has strong potential to facilitate the accurate and rapid diagnosis of vertebral diseases.
| S-EPMC10784083 | biostudies-literature
Project description:Bertolotti's syndrome (BS) refers to the possible association between the congenital malformation lumbosacral transitional vertebra (LSTV), and low back pain (LBP). Several treatments have been proposed including steroid injections, resections of the LSTV, laminectomy, and lumbar spinal fusion. The aim of this review was to compare the clinical outcomes in previous trials and case reports for these treatments in patients with LBP and LSTV. A PubMed search was conducted. We included English studies of patients diagnosed with LSTV treated with steroid injection, laminectomy, spinal fusion or resection of the transitional articulation. Of 272 articles reviewed 20 articles met the inclusion criteria. Their level of evidence were graded I-V and the clinical outcomes were evaluated. Only 1 study had high evidence level (II). The remainders were case series (level IV). Only 5 studies used validated clinical outcome measures. A total of 79 patients were reported: 31 received treatment with steroid injections, 33 were treated with surgical resection of the LSTV, 8 received lumbar spinal fusion, and 7 cases were treated with laminectomy. Surgical management seems to improve the patient's symptoms, especially patients diagnosed with "far out syndrome" treated with laminectomy. Clinical outcomes were more heterogenetic for patient's treated with steroid injections. The literature regarding BS is sparse and generally with low evidence. Non-surgical management (e.g., steroid injections) and surgical intervention could not directly be compared due to lack of standardization in clinical outcome. Generally, surgical management seems to improve patient's clinical outcome over time, whereas steroid injection only improves the patient's symptoms temporarily. Further studies with larger sample size and higher evidence are warranted for the clinical guidance in the treatment of BS.
| S-EPMC5731823 | biostudies-other
Project description:PURPOSE:Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images. METHODS:A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chi-square test and two-sided Fisher's exact test. A p value of less than 0.05 was considered statistically significant. RESULTS:A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients). CONCLUSION:The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.
| S-EPMC7296357 | biostudies-literature
Project description:Quantitative computed tomography (QCT)-based finite element (FE) models of the vertebra are widely used in studying spine biomechanics and mechanobiology, but their accuracy has not been fully established. Although the models typically assign material properties based only on local bone mineral density (BMD), the mechanical behavior of trabecular bone also depends on fabric. The goal of this study was to determine the effect of incorporating measurements of fabric on the accuracy of FE predictions of vertebral deformation. Accuracy was assessed by using displacement fields measured via digital volume correlation-applied to time-lapse microcomputed tomography (μCT)-as the gold standard. Two QCT-based FE models were generated from human L1 vertebrae (n = 11): the entire vertebral body and a cuboid-shaped portion of the trabecular centrum [dimensions: (20-30) × (15-20) × (15-20) mm3]. For axial compression boundary conditions, there was no difference (p = 0.40) in the accuracy of the FE-computed displacements for models using material properties based on local values of BMD versus those using material properties based on local values of fabric and volume fraction. However, when using BMD-based material properties, errors were higher for the vertebral-body models (8.4-50.1%) than cuboid models (1.5-19.6%), suggesting that these properties are inaccurate in the peripheral regions of the centrum. Errors also increased when assuming that the cuboid region experienced uniaxial loading during axial compression of the vertebra. These findings indicate that a BMD-based constitutive model is not sufficient for the peripheral region of the vertebral body when seeking accurate QCT-based FE modeling of the vertebra.
| S-EPMC7062572 | biostudies-literature
Project description:As in clinical studies, finite element analysis (FEA) developed from computed tomography (CT) images of bones are useful in pre-clinical rodent studies assessing treatment effects on vertebral body (VB) strength. Since strength predictions from microCT-derived FEAs (μFEA) have not been validated against experimental measurements of mouse VB strength, a parametric analysis exploring material and failure definitions was performed to determine whether elastic μFEAs with linear failure criteria could reasonably assess VB strength in two studies, treatment and genetic, with differences in bone volume fraction between the control and the experimental groups. VBs were scanned with a 12-μm voxel size, and voxels were directly converted to 8-node, hexahedral elements. The coefficient of determination or R (2) between predicted VB strength and experimental VB strength, as determined from compression tests, was 62.3% for the treatment study and 85.3% for the genetic study when using a homogenous tissue modulus (E t) of 18 GPa for all elements, a failure volume of 2%, and an equivalent failure strain of 0.007. The difference between prediction and measurement (that is, error) increased when lowering the failure volume to 0.1% or increasing it to 4%. Using inhomogeneous tissue density-specific moduli improved the R (2) between predicted and experimental strength when compared with uniform E t=18 GPa. Also, the optimum failure volume is higher for the inhomogeneous than for the homogeneous material definition. Regardless of model assumptions, μFEA can assess differences in murine VB strength between experimental groups when the expected difference in strength is at least 20%.
| S-EPMC4407510 | biostudies-other
Project description:Background ?Advancements in radiological imaging and diagnostic criteria enable doctors to more accurately identify lumbosacral transitional vertebrae (LSTV) and their association with back and L5 distribution leg pain. It is considered the most common congenital anomaly of the lumbosacral spine with an incidence between 4 and 35%, 3 although many practitioners describe 10 to 12% overall incidence. LSTVs include sacralization of the L5 vertebral body and lumbarization of the S1 segment while demonstrating varying morphology, ranging from broadened transverse processes to complete fusion. 5 The most common types of LSTV that present with symptomatic Bertolotti's syndrome are the Castellvi type I and type II; type III and type IV variants rarely present with symptoms referable with confirmatory and provocative testing to the transitional vertebra itself, and therefore there is limited experience and no case reports of treatment toward this particular entity. Case Description ?We illustrated a case of a 37 years old female in which a computed tomography scan demonstrated type III LSTV on the left and a type I anomaly on the right. The patient presented with right-sided leg pain and left-sided sacroiliac (SI) region low back pain, worse with rotation and standing, for several years, and had been on daily narcotic pain medications for more than 2 years. The patient had temporary relief of her leg pain with a transverse/ALA injection on the right, but no improvement in her back pain, whereas a left-sided injection into the region around the type III interface on the left did transiently alleviate her SI pain without improvement in her leg pain. We proposed that this particular anomaly induced mechanical back pain on the left side by flexion of the bone bridge (a form of stress-fracture, with associated sclerotic changes in the interface in the transverse/ALA junction) with associated irritation of the right L5 nerve from the type I anomaly on the right in conjunction with her typical radiating leg pain on the right. A patent, but somewhat hypoplastic L5/S1 disk space was also present. Nonsegmental pedicle screw instrumentation with low-profile screws was implanted on the right side with fusion induced using allograft and off label use of infuse rh-BMP2 bone graft substitute, and the patient was discharged the same day. The patient noted immediate improvement in her preoperative symptoms, and by 2 weeks after her surgery noted complete resolution of the preoperative symptoms, and required no narcotic medications to control her incisional pain. Conclusion ?Patients who present with symptoms consistent with Bertolotti's syndrome, even if they have a type III or type IV LSTV, should be considered for surgical treatment of their LSTV. These patients can respond well, even if symptoms have been present for years. Given the prevalence of these anatomic variants in the general population (10-12% in most series), Bertolotti's syndrome should be considered in the differential diagnosis of any patient with a presentation of L5 radiculopathy and/or back pain.
| S-EPMC6066366 | biostudies-other
Project description:To assess the prevalence and degree of lumbosacral transitional vertebrae (LSTV) in the Osteoarthritis Initiative (OAI) cohort, to assess whether LSTV correlates with low back pain (LBP) and buttock pain, and to assess the reproducibility of grading LSTV.Institutional review board approval was obtained, and informed consent documentation was approved for the study protocol. Standard standing pelvic radiographs that included the transverse processes of L5 were graded according to Castellvi classification of LSTV in 4636 participants (1992 men and 2804 women; aged 45-80 years) from the OAI cohort. These data were correlated with prevalence and severity of LBP and buttock pain.Prevalence of LSTV was 18.1% (841 of 4636), with a higher rate in men than in women (28.1% vs 11.1%, respectively; P<.001). Of the 841 individuals with LSTV, 41.72% were type I (dysplastic enlarged transverse process), 41.4% were type II (pseudoarticulation), 11.5% were type III (fusion), and 5.2% were type IV (one transverse process fused and one with pseudoarticulation). Of the participants without LSTV, 53.9% reported LBP, while the prevalence of LBP for types I, II, III, and IV was 46%, 73%, 40%, and 66%, respectively (P<.05, χ2 test). Types II and IV had higher prevalence and severity of LBP and buttock pain (P<.001).LSTV types II and IV positively correlate with prevalence and severity of LBP and buttock pain.
| S-EPMC3480814 | biostudies-other
Project description:PurposeTo compare the delivered radiation dose between a low-dose hip computed tomography (CT) scan protocol and traditional hip CT scan protocols (i.e., "traditional CT").MethodsThis was a retrospective comparative cohort study. Patients who underwent hip-preservation surgery (including arthroscopy, surgical hip dislocation, or periacetabular osteotomy procedures) at our institution between 2016 and 2017 were identified. Patients were excluded if they had a body mass index (BMI) greater than 35, they underwent previous surgery, or a radiation dose report was absent. The low-dose group included patients who underwent hip CT at our institution using a standardized protocol of 100 kV (peak), 100 milliampere-seconds (mAs), and a limited scanning field. The traditional CT group included patients who had hip CT scans performed at outside institutions. The total effective dose (Ehip), effective dose per millimeter of body length scanned, patients' age, and patients' BMI were compared by univariate analysis. The correlation of Ehip to BMI was assessed.ResultsThe study included 41 consecutive patients in the low-dose group and 18 consecutive patients in the traditional CT group. Low-dose CT resulted in a 90% reduction in radiation exposure compared with traditional CT (Ehip, 0.97 ± 0.28 mSv vs 9.68 ± 6.67 mSv; P < .0001). Age (28 ± 11 years vs 26 ± 10 years, P = .42), sex (83% female patients vs 76% female patients, P = .74), and BMI (24 ± 3 vs 24 ± 3, P = .75) were not different between the 2 groups. Ehip had a poor but significant correlation to BMI in the low-dose CT group (R2 = 0.14, slope = 0.03, P = .02) and did not correlate to BMI in the traditional CT group (R2 = 0.13, P = .14).ConclusionsA low-dose hip CT protocol for the purpose of hip-preservation surgical planning resulted in a 90% reduction in radiation exposure compared with traditional CT.Level of evidenceLevel II, diagnostic study.
| S-EPMC6500754 | biostudies-literature