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Substantial vertebral body osteophytes protect against severe vertebral fractures in compression.

ABSTRACT: Recent findings suggest that vertebral osteophytes increase the resistance of the spine to compression. However, the role of vertebral osteophytes on the biomechanical response of the spine under fast dynamic compression, up to failure, is unclear. Seventeen human spine specimens composed of three vertebrae (from T5-T7 to T11-L1) and their surrounding soft tissues were harvested from nine cadavers, aged 77 to 92 years. Specimens were imaged using quantitative computer tomography (QCT) for medical observation, classification of the intervertebral disc degeneration (Thomson grade) and measurement of the vertebral trabecular density (VTD), height and cross-sectional area. Specimens were divided into two groups (with (n = 9) or without (n = 8) substantial vertebral body osteophytes) and compressed axially at a dynamic displacement rate of 1 m/s, up to failure. Normalized force-displacement curves, videos and QCT images allowed characterizing failure parameters (force, displacement and energy at failure) and fracture patterns. Results were analyzed using chi-squared tests for sampling distributions and linear regression for correlations between VTD and failure parameters. Specimens with substantial vertebral body osteophytes present higher stiffness (2.7 times on average) and force at failure (1.8 times on average) than other segments. The presence of osteophytes significantly influences the location, pattern and type of fracture. VTD was a good predictor of the dynamic force and energy at failure for specimens without substantial osteophytes. This study also showed that vertebral body osteophytes provide a protective mechanism to the underlying vertebra against severe compression fractures.

SUBMITTER: Wagnac E

PROVIDER: S-EPMC5655488 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Substantial vertebral body osteophytes protect against severe vertebral fractures in compression.

Wagnac Eric E Aubin Carl-Éric CÉ Chaumoître Kathia K Mac-Thiong Jean-Marc JM Ménard Anne-Laure AL Petit Yvan Y Garo Anaïs A Arnoux Pierre-Jean PJ

PloS one 20171024 10

Recent findings suggest that vertebral osteophytes increase the resistance of the spine to compression. However, the role of vertebral osteophytes on the biomechanical response of the spine under fast dynamic compression, up to failure, is unclear. Seventeen human spine specimens composed of three vertebrae (from T5-T7 to T11-L1) and their surrounding soft tissues were harvested from nine cadavers, aged 77 to 92 years. Specimens were imaged using quantitative computer tomography (QCT) for medica ...[more]

PMID: 29065144

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Project description:Purpose To create and validate a computer system with which to detect, localize, and classify compression fractures and measure bone density of thoracic and lumbar vertebral bodies on computed tomographic (CT) images. Materials and Methods Institutional review board approval was obtained, and informed consent was waived in this HIPAA-compliant retrospective study. A CT study set of 150 patients (mean age, 73 years; age range, 55-96 years; 92 women, 58 men) with (n = 75) and without (n = 75) compression fractures was assembled. All case patients were age and sex matched with control subjects. A total of 210 thoracic and lumbar vertebrae showed compression fractures and were electronically marked and classified by a radiologist. Prototype fully automated spinal segmentation and fracture detection software were then used to analyze the study set. System performance was evaluated with free-response receiver operating characteristic analysis. Results Sensitivity for detection or localization of compression fractures was 95.7% (201 of 210; 95% confidence interval [CI]: 87.0%, 98.9%), with a false-positive rate of 0.29 per patient. Additionally, sensitivity was 98.7% and specificity was 77.3% at case-based receiver operating characteristic curve analysis. Accuracy for classification by Genant type (anterior, middle, or posterior height loss) was 0.95 (107 of 113; 95% CI: 0.89, 0.98), with weighted κ of 0.90 (95% CI: 0.81, 0.99). Accuracy for categorization by Genant height loss grade was 0.68 (77 of 113; 95% CI: 0.59, 0.76), with a weighted κ of 0.59 (95% CI: 0.47, 0.71). The average bone attenuation for T12-L4 vertebrae was 146 HU ± 29 (standard deviation) in case patients and 173 HU ± 42 in control patients; this difference was statistically significant (P < .001). Conclusion An automated machine learning computer system was created to detect, anatomically localize, and categorize vertebral compression fractures at high sensitivity and with a low false-positive rate, as well as to calculate vertebral bone density, on CT images. © RSNA, 2017 Online supplemental material is available for this article.

Project description:Purpose:We aimed to retrospectively assess the incidence of vertebral compression fractures (VCF), examine clinicopathologic factors potentially associated with VCF, and evaluate treatment response in patients who received stereotactic body radiotherapy (SBRT) for spine metastases (spMets). Methods and Materials:We identified 78 patients with 125 spMets at baseline and subsequent assessments. Patients received SBRT doses of 16 or 18 Gy. Patients with pre-existing VCF and co-existing local progression were excluded. Spine instability neoplastic score (SINS) was used for spMets categorization. Response to SBRT and VCF were assessed according to the Positron Emission tomography Response Criteria In Solid Tumors (PERCIST) and Genant scores, respectively. Kaplan-Meier analyses were used to assess local control of disease and vertebral compression fracture-free survival (FFS). Results:We treated 103 cases with single spMets and 11 cases involving double spMets with SBRT. Progressive disease was reported in 3.2% and 8.2% of the cases in the first and last PET/CT reports, respectively. The distribution of treatment response in the remaining patients was: complete response in 30.6% of patients, partial response in 47.1% of patients, and stable disease in 22.3% of patients in the first PET/CT; complete response in 62.3% of patients, partial response in 16.7% of patients, and stable disease in 21% of patients at the last monitoring. Local failures were observed in 15 (12%) of cases. Median SINS was 5 (range: 1-13); majority of patients in our cohort (70.4%) were categorized as stable according to SINS, five (4%) patients had Grade 3 VCF at a median time of 16 months after SBRT (range: 2-22 months), and 60% of VCF occurred after an interval of at least 12 months after SBRT. No bisphosphonate usage was significantly associated with VCF (r = -0.204; p = 0.022). Median FFS was 21 months. Univariate analyses indicated that female gender (p < 0.001), bisphosphonate use (p = 0.005), >6 months of bisphosphonates use (p = 0.002), and the lowest vertebral body collapse score (p = 0.023) were associated with higher FFS. Female gender (p = 0.007), >6 months of bisphosphonates usage (p = 0.018), and the lowest vertebral body collapse score (p = 0.044) retained independent significance. Conclusions:This study demonstrated that spine SBRT with doses of 16-18 Gy promises good local control of disease with acceptable VCF rates. Lowest vertebral body collapse score, female gender, and >6 months of bisphosphonate use were significantly associated with longer FFS.

Project description:BackgroundTo investigate whether thoracolumbar kyphosis (TLK) of the spine is related to the reduction of bone mineral density (BMD) in postmenopausal osteoporosis women, and whether BMD of postmenopausal osteoporosis women can predict the occurrence of TLK.MethodsThis retrospective cohort study included 224 postmenopausal female patients hospitalized for osteoporosis from December 2017 to December 2020, and the control group included 270 postmenopausal female patients hospitalized for thoracolumbar degenerative diseases. The age, body mass index (BMI), visual analogue scale (VAS), and BMD of the lumbar spine [BMD(L)] and femoral neck [BMD(F)] of all patients during admission were recorded. We measured and recorded the Cobb angle of thoracolumbar and the height of the thoracolumbar intervertebral space in the spinal X-ray lateral radiograph. The Pearson and Spearman correlation coefficients were used to calculate the correlation between each parameter in the group. The Chi-square test was used for categorical variables, the independent-sample t-test was used for normally distributed continuous variables, and two-sample non-parametric tests were used for non-normally distributed variables. Binary logistic regression analysis and receiver operating characteristic (ROC) curves were applied to determine independent risk factors and cut-off values, respectively.ResultsThere were significant differences in the BMD(L), BMD(F), thoracolumbar junction Cobb angle, lumbar spine Cobb angle, T11/12-L1/2 height difference of the posterior and anterior edge of intervertebral space (HDPAIS), single vertebra Cobb angle (SVC), procollagen type 1 N-terminal propeptide (PINP) and 25-hydroxyvitamin D [25-(OH)D] between the study and control groups. Through binary logistic regression analysis, we found that BMD(L), PINP, bone alkaline phosphatase, and 25-(OH)D were independent risk factors for future TLK in postmenopausal women. According to the ROC curve, the prediction accuracy of BMD(L) was the highest. By calculating the critical value, we found that when the BMD(L) T-score <-1.65, postmenopausal women were more likely to develop TLK.ConclusionsIn postmenopausal osteoporosis patients, TLK will occur even if there is no compression fracture, and when the BMD(L) T-score <-1.65, postmenopausal women are more likely to develop TLK in the future.

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Substantial vertebral body osteophytes protect against severe vertebral fractures in compression.

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Substantial vertebral body osteophytes protect against severe vertebral fractures in compression.

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