The quality of bone and paraspinal muscle in the fragility osteoporotic vertebral compression fracture: a comprehensive comparison between different indicators.

PURPOSE: To evaluate the value of five indicators in predicting OVCF through a retrospective case-control study, and explore the internal correlation of different indicators. METHOD: We retrospectively enrolled patients over 50 years of age who had been subjected to surgery for fragility OVCF at China Japan Friendship Hospital from January 2021 to September 2023. Demographic characteristics, T-score based on dual-energy X-ray absorptiometry (DXA), CT-based Hounsfield unit (HU) value, vertebral bone quality (VBQ) score based on magnetic resonance imaging (MRI), relative cross-sectional area (rCSA) and the rate of fat infiltration (FI) of paraspinal muscle were collected. A 1:1 age- and sex-matched, fracture-free control group was established from patients admitted to our hospital for lumbar spinal stenosis or lumbar disk herniation. RESULTS: A total of 78 patients with lumbar fragility OVCF were included. All the five indicators were significantly correlated with the occurrence of OVCFs. Logistic regression analysis showed that average HU value and VBQ score were significantly correlated with OVCF. The area under the curve (AUC) of VBQ score was the largest (0.89). There was a significantly positive correlation between average T-score, average HU value and average total rCSA. VBQ score was significantly positive correlated with FI. CONCLUSION: VBQ score and HU value has good value in predicting of fragility OVCF. In addition to bone mineral density, we should pay more attention to bone quality, including the fatty signal intensity in bone and the FI in paraspinal muscle.

Evaluation of Sarcopenia by Psoas Muscle Measurements in Osteoporotic Patients with Vertebral Compression Fracture.

OBJECTIVE: To examine the effect of sarcopenia on osteoporotic vertebral compression fracture with psoas muscle measurements. STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: Department of Radiology, Sivas Cumhuriyet University, Sivas, Turkiye, from January 2020 to March 2023. METHODOLOGY: Measurements evaluating psoas muscle area (PMA), psoas muscle index (PMI), and psoas muscle density (PMD) were made at L2 vertebral corpus level for the diagnosis of sarcopenia from muscle mass with computed tomography (CT). The association between sarcopenia and osteoporotic compression fracture was examined with significance at p <0.05. RESULTS: Osteoporotic patients with 37 compression fractures and 37 without compression fractures were examined. PMA and PMI were statistically significantly lower in the study group (p <0.01). PMD was also found to be statistically significantly lower in the study group (p <0.05). Diagnostic performance (DP) was good for the discrimination of patients and control groups for psoas area (AUC = 0.88; 95% confidence interval (CI) 0.807 - 0.956 and PMI (AUC = 0.83; 95% CI 0.734 - 0.917. It was poor for psoas density (AUC = 0.66, 95% CI 0.531 - 0.782). CONCLUSION: Sarcopenia is an important risk factor for osteoporotic compression fracture. Psoas measurements show a significant association with osteoporosis and vertebral fracture and can be easily determined on CT scan. KEY WORDS: Sarcopenia, Osteoporotic compression fracture, Psoas muscle.

A Novel Leverage Technique Using Monoaxial Pedicle Screw for Reduction of Thoracolumbar Compression Fractures: Surgical Technique and Analysis of Radiological Parameters.

OBJECTIVE: Thoracolumbar compression fractures resulting from high-energy injuries are a common type of spinal fracture. Satisfying reduction of compressive vertebra body is essential for the clinical outcome. However, traditional distraction technique may lead to complications including pedicle screw loosening, pedicle screw breakage, and postoperative back pain because of excessive distraction. In this study, we reported a novel technique for reduction. Additionally, the effect and postoperative radiological parameters of this technique were compared with those of traditional distraction technique. METHODS: The clinical data of 80 patients who had been treated with posterior pedicle screw fixation from January 2019 to December 2020 was retrospectively analyzed. Thirty-six patients were performed with the leverage technique, while 22 patients were treated with the traditional distraction technique. When pedicle screw fixation was performed with either the leverage technique or the traditional distraction technique, fracture reduction was completed with monoaxial pedicle screws using either the leverage maneuver or distraction of adjacent vertebrae. Clinical evaluation, including operation time, hospital stay, blood loss volume, and postoperative complications were collected. The American Spinal Injury Association (ASIA) score for neurological condition and the visual analog scale (VAS) score for pain were used to evaluate the patients' functional outcome. The radiographic analysis included local kyphotic angle (LKA), regional kyphotic angle (RKA), anterior vertebral height (AVH), posterior vertebral height (PVH), and sagittal compression (SC). The student t-test and the χ2-test (or the Fisher exact test) were used to compare the outcome measures between the two groups. RESULTS: The leverage group comprised 36 patients, while 44 patients were included in the distraction group. No statistically significant differences were found in the demographic data. The VAS score in the leverage group (3.0 ± 0.8) was significantly lower than that in the distraction group (4.2 ± 0.6) on postoperative day 1. Total correction of the LKA in the leverage group (11.5 ± 2.5°) was significantly higher than that in the distraction group (7.1 ± 1.3°) (p = 0.0004). Total correction of the RKA was higher in the leverage group (12.1 ± 4.3°) than in the distraction group (6.1 ± 0.9°) (p = 0.005). The ratio of rear pillar /front pillar correction was 0.35 ± 0.13 and 0.89 ± 0.18 in the leverage and distraction groups, respectively (p = 0.014). Total correction of the upper and lower foraminal height in the leverage group was significantly less than that in the distraction group. The leverage group had significantly higher correction of the upper and lower intervertebral space height than the distraction group. CONCLUSIONS: Our novel leverage technique provided better kyphotic reduction and restoration than compared to conventional distraction technique in the surgical treatment of thoracolumbar compression fractures.

The Closer Vicinity to Treated Vertebrae in Percutaneous Vertebroplasty, the Higher Rate of New Vertebral Compression Fractures at Follow-up.

OBJECTIVE: To investigate whether risk of new vertebral compression fractures (NVCFs) was associated with vicinity to treated vertebrae in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs). METHODS: All OVCF (T6-L5) patients treated with PVP between January 2016 and December 2020 were retrospectively reviewed. Vicinity to treated vertebrae was defined as the number of vertebrae between an untreated and its closest treated level. The closest treated level was chosen as reference vertebra. Clinical, radiologic, and surgical parameters were compared between groups of reference vertebrae for each vicinity NVCF. RESULTS: In total, 1348 patients with 1592 fractured and 14,584 normal vertebrae were enrolled. NVCF was identified in 20.1% (271 of 1348) patients in 2.2% (319 of 14584) vertebrae in a mean follow-up time of 24.3 ± 11.9 months. Rate of NVCF in vicinity 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and 11 level were 4.6% (130 of 2808), 2.4% (62 of 2558), 1.8% (42 of 2365), 1.5% (31 of 2131), 1.3% (23 of 1739), 1.3% (17 of 1298), 0.8% (7 of 847), 0.9% (4 of 450), 0.8% (2 of 245), 0.9% (1 of 117), and 0% (0 of 26), respectively. Rate of NVCF in vicinity 1 level was significantly higher than that in vicinity 2, 3, 4, 5, 6, 7, 8, and 9 level, respectively. However, compared to reference vertebrae for vicinity 1 NVCF, any clinical, radiologic, or surgical parameters were not significantly different in those for vicinity 2, 3, and 4 NVCF, respectively. CONCLUSIONS: The closer vicinity to treated vertebrae in PVP, the higher rate of NVCF at follow-up. However, any clinical, radiologic, or surgical parameters might not matter in this phenomenon of vicinity-related NVCF.

Prediction of Subsequent Vertebral Fracture After Acute Osteoporotic Fractures from Clinical and Paraspinal Muscle Features.

To construct a nomogram based on clinical factors and paraspinal muscle features to predict vertebral fractures occurring after acute osteoporotic vertebral compression fracture (OVCF). We retrospectively enrolled 307 patients with acute OVCF between January 2013 and August 2022, and performed magnetic resonance imaging of the L3/4 and L4/5 intervertebral discs (IVDs) to estimate the cross-sectional area (CSA) and degree of fatty infiltration (FI) of the paraspinal muscles. We also collected clinical and radiographic data. We used univariable and multivariable Cox proportional hazards models to identify factors that should be included in the predictive nomogram. Post-OVCF vertebral fracture occurred within 3, 12, and 24 months in 33, 69, and 98 out of the 307 patients (10.8%, 22.5%, and 31.9%, respectively). Multivariate analysis revealed that this event was associated with percutaneous vertebroplasty treatment, higher FI at the L3/4 IVD levels of the psoas muscle, and lower relative CSA of functional muscle at the L4/5 IVD levels of the multifidus muscle. Area under the curve values for subsequent vertebral fracture at 3, 12, and 24 months were 0.711, 0.724, and 0.737, respectively, indicating remarkable accuracy of the nomogram. We developed a model for predicting post-OVCF vertebral fracture from diagnostic information about prescribed treatment, FI at the L3/4 IVD levels of the psoas muscle, and relative CSA of functional muscle at the L4/5 IVD levels of the multifidus muscle. This model could facilitate personalized predictions and preventive strategies.

A study on vertebral refracture and scoliosis after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fractures.

PURPOSE: To analyze the association between scoliosis and vertebral refracture after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCFs). METHODS: A retrospective study was conducted on 269 patients meeting the criteria from January 2014 to October 2022. All patients underwent PKP with complete data and were followed-up for > 12 months. First, it was verified that scoliosis was a risk factor in 269 patients. Second, patients with scoliosis were grouped based on the Cobb angle to evaluate the impact of the post-operative angle. The cox proportional hazards regression analysis and survival analysis were used to calculate the hazard ratio and recurrence time. RESULTS: A total of 56 patients had scoliosis, 18 of whom experienced refractures after PKP. The risk factors for vertebral refractures included a T-score < - 3.0 and presence of scoliosis (both p < 0.001). The results indicated that the vertebral fractured arc (T10 - L4) was highly influential in scoliosis and vertebral fractures. When scoliotic and initially fractured vertebrae were situated within T10 - L4, the risk factors for vertebral refracture included a postoperative Cobb angle of ≥ 20° (p = 0.002) and an increased angle (p = 0.001). The mean recurrence times were 17.2 (10.7 - 23.7) months and 17.6 (7.9 - 27.3) months, respectively. CONCLUSION: Osteoporosis combined with scoliosis significantly increases the risk of vertebral refractures after PKP in patients with OVCFs. A postoperative Cobb angle of ≥ 20° and an increased angle are significant risk factors for vertebral refractures when scoliotic and initially fractured vertebrae are situated within T10 - L4.

Enhancing percutaneous kyphoplasty efficacy in elderly osteoporotic fractures through optimal cement filling ratio.

Objective: To explore the appropriate bone cement filling ratio in percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCF). Methods: Clinical and radiological data from 150 OVCF patients treated with PKP were retrospectively analyzed. Patients were categorized into three groups based on bone cement filling ratio: low (<0.4), medium (0.4-0.6), and high (>0.6) filling ratio groups. The clinical characteristics (age, gender, BMI, etc.) and related study data (bone cement leakage and its location, pre/post-operative Visual Analogue Scale (VAS), pre/post-operative Oswestry Disability Index (ODI), vertebral height restoration, kyphotic Cobb angle, etc.) among the three groups were compared using statistical software to compare to identify the most appropriate cement filling ratio. Results: The 0.4-0.6 group presented a lower cement leakage rate compared to the >0.6 group, and there were no significant differences in pre-operative VAS, post-operative day 2 VAS, post-operative month 1 VAS, and pre-operative ODI (p>0.05). However, significant differences were observed in post-operative month 3 VAS (p=0.002), post-operative day 2 ODI (p=0.002), post-operative month 1 ODI (p<0.001), and post-operative month 3 ODI (p<0.001). The "0.4-0.6" group showed better pain improvement and functional recovery compared with the ">0.6" group at the 3-month follow-up. While presenting the best vertebral height restoration, the ">0.6" group also exhibited the greatest variability. Additionally, no significant difference in Cobb angle changes was observed among the groups. Conclusion: A bone cement filling ratio of 0.4-0.6 in PKP treatment for OVCF strikes a favorable balance between complication reduction and positive patient outcomes, warranting it as an optimal filling volume.

Multiple back fractures as a result of the first seizure.

Non-traumatic fractures due to seizures are an overlooked diagnostic group. It is well known that patients with generalized tonic-clonic seizures have an increased trauma risk. However, the cause of fracture is rarely due to the violent forces of muscle contractions. Usually, the primary patient examination focuses on the aetiology of the seizure, which sometimes delays the diagnosis of fractures. This is a case report of a 19-year-old woman who sustained three compression fractures of the thoracic spine due to a generalized tonic-clonic seizure, and a discussion of the diagnostic challenges in such a rare case.

Percutaneous kyphoplasty with or without posterior pedicle screw fixation for the management of severe osteoporotic vertebral compression fractures with nonunion.

OBJECTIVE: To assess the radiographic outcomes, clinical outcomes and complications of percutaneous kyphoplasty (PKP) with and without posterior pedicle screw fixation (PPSF) in the treatment of severe osteoporotic vertebral compression fractures (sOVCF) with nonunion. METHODS: This study involved 51 patients with sOVCF with nonunion who underwent PKP or PPSF + KP. The operation time, intraoperative blood loss, volume of injected bone cement, operation costs and hospital stays were all recorded. In addition, the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were assessed separately for each patient before and after surgery. RESULTS: Compared with the PPSF + KP group, the PKP group had shorter operation time, less intraoperative blood loss, shorter hospital stays and fewer operation costs. However, cobb's angle improvement (13.4 ± 4.3° vs. 21.4 ± 5.3°), VWR improvement ratio (30.4 ± 11.5% vs. 52.8 ± 12.7%), HA (34.9 ± 9.0% vs. 63.7 ± 7.6%) and HM (28.4 ± 11.2% vs. 49.6 ± 7.7%) improvement ratio were all higher in PPSF + KP group than that in PKP group. In addition, the ODI index and VAS score in both groups were significantly decreased at the postoperative and final follow-up. PKP group's postoperative VAS score was significantly lower than that in PPSF + KP group, but there was no statistically significant difference in VAS score at the last follow-up. CONCLUSION: PKP and PPSF + KP can both effectively relieve the pain associated with sOVCF with nonunion. PPSF + KP can achieve more satisfactory vertebral reduction effects compared to PKP. However, PKP was less invasive and it has more advantages in shortening operation time and hospital stay, as well as decreasing intraoperative blood loss and operation costs.

Percutaneous kyphoplasty through unilateral puncture on the convex side for the treatment of painful osteoporotic vertebral compression fracture with scoliosis.

PURPOSE: To assess the clinical safety, accuracy, and efficacy of percutaneous kyphoplasty (PKP) surgery using an enhanced method of unilateral puncture on the convex side for the treatment of painful osteoporotic vertebral compression fractures (P-OVCF) with scoliosis. METHODS: Clinical and radiographic data of P-OVCF patients with scoliosis who underwent PKP via unilateral puncture on the convex side from January 2018 to December 2021 were retrospectively analyzed. This technique's detailed surgical steps and tips were described. The local kyphosis angle (LKA), scoliosis Cobb angle (SCA), and local scoliosis Cobb angle (LSCA) were measured using X-ray and compared at pre-operation, post-operation, and the last follow-up. The width of pedicle (POW), inner inclination angle (IIA), lateral distance (LD), and puncture course length (PCL) were measured on the axial computed tomography image and compared between two sides. Postoperative computed tomography was employed to evaluate the condition of cement distribution and puncture. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back pain (BP). RESULTS: Thirty-six patients, 23 women and 13 men, with an average age of 76.31 ± 6.28 years were monitored for 17.69 ± 4.70 months. The median surgical duration of single vertebrae was 35 min. The volume of bone cement for single vertebrae was 3.81 ± 0.87 ml and the proportion of sufficient cement distribution of the patients was 97.22. LKA was considerably improved from pre-operation to post-operation and sustained at the last follow-up. SCA and LSCA were not significantly modified between these three-time points. IIA, PCL, and LD were lower on the convex side than on the concave side. POW was considerably wider on the convex side. The ODI and VAS-BP scores were significantly improved after surgery and sustained during the follow-up. CONCLUSIONS: Combining with the proper assessment of the pre-injured life status of patients, PKP surgery using unilateral puncture on the convex side for the treatment of P-OVCF with scoliosis can achieve safe, excellent clinical, and radiographic outcomes.

Risk factors for nonunion of osteoporotic vertebral compression fracture: a case‒control study.

BACKGROUND: Early assessment of the risk of nonunion in osteoporotic vertebral compression fracture (OVCF) is beneficial to early clinical decision making. However, a comprehensive understanding of the risk factors for OVCF nonunion is lacking. METHODS: We conducted a case-control study to investigate risk factors for OVCF nonunion. Patients who underwent surgery for nonunited OVCFs between January 2011 and December 2021 were eligible for inclusion as cases. Patients with successful OVCF healing confirmed by MRI over the same period were identified as controls. Patient demographics, comorbidities, and fasting blood test data were extracted for analysis. RESULTS: A total of 201 patients with nonunited OVCFs and 1044 controls were included to evaluate the risk factors for nonunited OVCFs. There were statistically significant differences in sex, age, number of patients with hypertension, number of patients on bed rest after OVCF and T-score of BMD between the two groups. Logistic regression showed that female patients had a higher risk of OVCF nonunion than male patients and that smoking, drinking, diabetes, and hypertension were risk factors for nonunion of OVCFs, while bed rest and spinal support were protective factors against nonunion of OVCFs. We also found that age, BMD, FBG, and ß-CTX were positively correlated with nonunited OVCFs, and that HGB and 1,25-(OH)2VitD3 level were negatively correlated with nonunited OVCFs. CONCLUSION: Smoking, drinking, diabetes and hypertension were risk factors for nonunion of OVCFs, while bed rest and spinal support were protective factors against nonunion of OVCFs. Age, BMD, FBG and ß-CTX were positively correlated with nonunited OVCFs, while HGB and 1,25-(OH)2VitD3 level were negatively correlated with nonunited OVCFs. Based on the results of our study, we suggest that bed rest or spinal support for at least 3 consecutive weeks is necessary to reduce the risk of OVCFs nonunion.

Plasma D-Dimer Levels Can Provide Useful Diagnostic Information on Acute Vertebral Compression Fractures in Patients with Low Back Pain in the Emergency Room.

BACKGROUND: Patients with acute vertebral compression fractures (aVCFs) are frequently transferred to an emergency department by ambulance. The most useful imaging modality is magnetic resonance imaging (MRI); however, which patients should be prioritized for MRI evaluation may be unclear. The aim of this study was to evaluate plasma D-dimer levels as a biomarker for aVCFs. METHODS: This retrospective cohort study included patients with low back pain in the emergency department between November 2017 and October 2020. Patients with infections, patients with coagulation disorders, and patients without D-dimer level measurements were excluded. The presence of an aVCF was detected with MRI. Blood samples were collected for routine blood tests. The predictive factors for aVCFs were evaluated with univariate and multivariable logistic regression analyses. RESULTS: Overall, 191 consecutive MRI evaluations were ordered. After exclusions, 101 patients were reviewed. Based on MRI, 65 (64.4%) patients were diagnosed with aVCF. The presence of aVCF was significantly correlated with age (odds ratio [OR] = 1.052, 95% confidence interval [CI] 1.018-1.191), an old vertebral compression fracture (OR = 3.290, 95% CI 1.342-8.075), hemoglobin (OR = 0.699, 95% CI 0.535-0.912), and D-dimer levels (OR = 1.829, 95% CI 1.260-2.656). Results from a multivariable logistic regression analysis showed that D-dimer levels (OR = 1.642, 95% CI 1.188-2.228) remained a significant risk factor for the presence of aVCFs after adjustment for potential confounders. CONCLUSIONS: Plasma D-dimer levels can provide useful diagnostic information about whether an aVCF is present.

Using advanced imaging to measure bone density, compression fracture risk, and risk for construct failure after spine surgery.

Low bone mineral density (BMD) can predispose to vertebral body compression fractures and postoperative instrumentation failure. DEXA is considered the gold standard for measurement of BMD, however it is not obtained for all spine surgery patients preoperatively. There is a growing body of evidence suggesting that more routinely acquired spine imaging studies such as computed tomography (CT) and magnetic resonance imaging (MRI) can be opportunistically used to measure BMD. Here we review available studies that assess the validity of opportunistic screening with CT-derived Hounsfield Units (HU) and MRI-derived vertebral vone quality (VBQ) to measure BMD of the spine as well the utility of these measures in predicting postoperative outcomes. Additionally, we provide screening thresholds based on HU and VBQ for prediction of osteopenia/ osteoporosis and postoperative outcomes such as cage subsidence, screw loosening, proximal junctional kyphosis, and implant failure.

Opportunistic Identification of Vertebral Compression Fractures on CT Scans of the Chest and Abdomen, Using an AI Algorithm, in a Real-Life Setting.

This study evaluated the performance of a vertebral fracture detection algorithm (HealthVCF) in a real-life setting and assessed the impact on treatment and diagnostic workflow. HealthVCF was used to identify moderate and severe vertebral compression fractures (VCF) at a Danish hospital. Around 10,000 CT scans were processed by the HealthVCF and CT scans positive for VCF formed both the baseline and 6-months follow-up cohort. To determine performance of the algorithm 1000 CT scans were evaluated by specialized radiographers to determine performance of the algorithm. Sensitivity was 0.68 (CI 0.581-0.776) and specificity 0.91 (CI 0.89-0.928). At 6-months follow-up, 18% of the 538 patients in the retrospective cohort were dead, 78 patients had been referred for a DXA scan, while 25 patients had been diagnosed with osteoporosis. A higher mortality rate was seen in patients not known with osteoporosis at baseline compared to patients known with osteoporosis at baseline, 12.8% versus 22.6% (p = 0.003). Patients receiving bisphosphonates had a lower mortality rate (9.6%) compared to the rest of the population (20.9%) (p = 0.003). HealthVCF demonstrated a poorer performance than expected, and the tested version is not generalizable to the Danish population. Based on its specificity, the HealthVCF can be used as a tool to prioritize resources in opportunistic identification of VCF's. Implementing such a tool on its own only resulted in a small number of new diagnoses of osteoporosis and referrals to DXA scans during a 6-month follow-up period. To increase efficiency, the HealthVCF should be integrated with Fracture Liaison Services (FLS).

Evaluation of Percutaneous Unilateral Kyphoplasty Results in Osteoporotic Vertebral Compression Fractures Using Individual 3D Printed Guide Template Support.

AIM: To compare the clinical and radiological outcomes of unilateral percutaneous kyphoplasty (PKP) surgeries performed using 3D printing technology in patients with osteoporotic compression fractures to conventional unilateral PKP surgeries. MATERIAL AND METHODS: Patients with acute painful single-level osteoporotic vertebral compression fracture (OVCF) who need surgical treatment were divided into two groups: group A (patients who had 3D template-guided PKP) and group B (patients who conventional PKP). To compare the two surgical procedures, Total Absorbed Radiation Dose (TARD), pre- and postoperative visual analog scale (VAS) scores, and Total Surgery Time (TST) were calculated and compared between groups in both surgical groups. RESULTS: A total of 44 patients with single-level OVCF who were experiencing acute pain were successfully operated on, with 22 patients in each group. TARD (2.6 ± 0.4 mGy vs. 6.1 ± 1.9 mGy, p < 0.05) and TST (12.4 ± 2.6 min vs. 20.2 ± 3.2 min, p < 0.05) differed significantly different between groups A and B. There was no statistically significant difference between the patient groups in preoperative and postoperative VAS values (p > 0.05). Cement leakage was lower in group A (3/22, 13.6%) than in group B (6/22, 27.3%) (p > 0.05). There were no neurological complications or infections in either group. CONCLUSION: When compared to the conventional procedure, the unilateral percutaneous kyphoplasty method was supported by a 3D printing guide template. By reducing operative time and radiation exposure, tt has resulted in a more effective surgical procedure for patients and a safer surgical procedure for surgeons and anaesthesiologists.

Stereotactic Body Radiation Therapy for Sacral Metastases: Deviation From Recommended Target Volume Delineation Increases the Risk of Local Failure.

PURPOSE: Although spine stereotactic body radiation therapy (SBRT) is considered a standard of care in the mobile spine, mature evidence reporting outcomes specific to sacral metastases is lacking. Furthermore, there is a need to validate the existing sacral SBRT international consensus contouring guidelines to define the optimal contouring approach. We report mature rates of local failure (LF), adverse events, and the effect of contouring deviations in the largest experience to date specific to sacrum SBRT. METHODS AND MATERIALS: Consecutive patients who underwent sacral SBRT from 2010 to 2021 were retrospectively reviewed. The primary endpoint was magnetic resonance imaging-based LF with a focus on adherence to target volume contouring recommendations. Secondary endpoints included vertebral compression fracture and neural toxicity. RESULTS: Of the 215 sacrum segments treated in 112 patients, most received 30 Gy/4 fractions (51%), 24 Gy/2 fractions (31%), or 30 Gy/5 fractions (10%). Sixteen percent of segments were nonadherent to the consensus guideline with a more restricted target volume (undercontoured). The median follow-up was 21.4 months (range, 1.5-116.9 months). The cumulative incidence of LF at 1 and 2 years was 18.4% and 23.1%, respectively. In those with guideline adherent versus nonadherent contours, the LF rate at 1 year was 15.1% versus 31.4% and at 2 years 18.8% versus 40.0% (hazard ratio [HR], 2.5; 95% CI, 1.4-4.6; P = .003), respectively. On multivariable analysis, guideline nonadherence (HR, 2.4; 95% CI, 1.3-4.7; P = .008), radioresistant histology (HR, 2.4; 95% CI, 1.4-4.1; P < .001), and extraosseous extension (HR, 2.5; 95% CI, 1.3-4.7; P = .005) predicted for an increased risk of LF. The cumulative incidence of vertebral compression fracture was 7.1% at 1 year and 12.3% at 2 years. Seven patients (6.3%) developed peripheral nerve toxicity, of whom 4 had been previously radiated. CONCLUSIONS: Sacral SBRT is associated with high efficacy rates and an acceptable toxicity profile. Adhering to consensus guidelines for target volume delineation is recommended to reduce the risk of LF.

Analysis of adjacent vertebral fracture after percutaneous vertebroplasty: do radiological or surgical features matter?

PURPOSE: To report the incidence and risk factors of adjacent vertebral fracture (AVF) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCFs). We focused to investigate effect of radiological or surgical features on AVF. METHODS: All patients with OVCFs who were treated with PVP between January 2016 and December 2019 were retrospectively reviewed. Patients were followed up at least 12 months after procedure according to treatment protocol. AVF was defined as postoperatively recurrent intractable back pain and subsequently presence of fracture on magnetic resonance imaging (MRI) in adjacent levels. Clinical, radiological, and surgical factors potentially affecting occurrence of AVF were recorded and analyzed using univariate and multivariate analysis. RESULTS: Totally, 1077 patients with 1077 fractured vertebrae who underwent PVP were enrolled in the study, after inclusion and exclusion criteria were met. Mean follow-up time was 24.3 ± 11.9 months (range, 12-59 months). AVF was identified in 98 (9.1%) patients. Univariate analysis showed that seven significant factors related to AVF were older age, non-traumatic fracture, cortical disruption on anterior wall, cortical disruption on lateral wall, basivertebral foramen, type-B leakage and type-C leakage. In multivariate analysis, two clinical factors, older age (P = 0.031) and non-traumatic fracture (P = 0.002), were significantly associated with AVF. However, any radiological or surgical factor did not reach significance in final model analysis. CONCLUSIONS: Incidence of AVF after PVP in patients with OVCFs was 9.1% (98/1077). Older age and non-traumatic fracture were two clinical risk factors for AVF. Neither radiological nor surgical feature was significantly correlated with AVF.

An overview of the performance of AI in fracture detection in lumbar and thoracic spine radiographs on a per vertebra basis.

PURPOSE: Subtle spinal compression fractures can easily be missed. AI may help in interpreting these images. We propose to test the performance of an FDA-approved algorithm for fracture detection in radiographs on a per vertebra basis, assessing performance based on grade of compression, presence of foreign material, severity of degenerative changes, and acuity of the fracture. METHODS: Thoracic and lumbar spine radiographs with inquiries for fracture were retrospectively collected and analyzed by the AI. The presence or absence of fracture was defined by the written report or cross-sectional imaging where available. Fractures were classified semi-quantitatively by the Genant classification, by acuity, by the presence of foreign material, and overall degree of degenerative change of the spine. The results of the AI were compared to the gold standard. RESULTS: A total of 512 exams were included, depicting 4114 vertebra with 495 fractures. Overall sensitivity was 63.2% for the lumbar spine, significantly higher than the thoracic spine with 50.6%. Specificity was 96.7 and 98.3% respectively. Sensitivity increased with fracture grade, without a significant difference between grade 2 and 3 compression fractures (lumbar spine: grade 1, 52.5%; grade 2, 72.3%; grade 3, 75.8%; thoracic spine: grade 1, 42.4%; grade 2, 60.0%; grade 3, 60.0%). The presence of foreign material and a high degree of degenerative changes reduced sensitivity. CONCLUSION: Overall performance of the AI on a per vertebra basis was degraded in clinically relevant scenarios such as for low-grade compression fractures.

'Skip' osteoporosis vertebral compression fractures caused by electrical injury: a case report and review of the literature.

INTRODUCTION: Electrical injuries rarely result in fractures, such as long bone fractures and spinal fractures. A few articles have reported osteoporosis vertebral compression fractures (OVCFs) caused by electrical injuries. Here, we present a rare case of 37-year-old male suffering from the 9th thoracic (T9) and 5th lumbar (L5) OVCFs after receiving a electric shock. CASE PRESENTATION: A 37-year-old Han male experienced an electric shock (480 V direct current) at the working time and felt immediately serious back pain. He did not fall and lose consciousness. X-ray and magnetic resonance imaging showed acute OVCFs, as well as dual-energy X-ray absorptiometry indicated osteoporosis. Normal laboratory tests can avoid secondary osteoporosis resulting from metabolic diseases and tumors. Finally, he was diagnosed with acute discontinuous OVCFs (T9 and L5). The patient denied having a history of back pain, whereas, he had a history of smoking, alcohol abuse, and congenital heart disease (tetralogy of Fallot) were associated with osteoporosis. Considering no local kyphosis and < 50% anterior body compression, we selected conservative treatment for this patient. At a 1-year and 3-year follow-up, the lateral thoracic and lumbar radiography demonstrated no instability of the spine, and the back pain has been relieved. CONCLUSIONS: This rare case reminds us the importance of consulting a detailed medical history when we encounter young patients receiving electrical injuries. Discontinuously OVCFs must not be overlooked, even though we encounter a young man.

The relationship between vertebral compression rates and systemic inflammatory scores in osteoporotic vertebral fractures.

OBJECTIVE: There are many scientific reports on systemic inflammation scores (SIS) associated with decreased bone mineral density in osteoporotic vertebral disease. However, there are no studies on the association of inflammation scores with the risk of collapse in osteoporotic vertebral collapse fractures. The aim of this study was to examine the correlation between the product of platelet and neutrophil counts (PPN), platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), and systemic immune inflammation index (SII) derived from complete blood count analysis in cases of osteoporotic vertebral fractures and fracture severity based on vertebral collapse rates. PATIENTS AND METHODS: This study is a retrospective analysis of a cohort of 50 patients aged 50 years or older who presented with osteoporotic vertebral fractures and underwent kyphoplasty at our clinic from 2018 to 2023. The study included both men and women. Computed tomography (CT) and magnetic resonance imaging (MRI) were used to diagnose and differentiate osteoporotic vertebral compression fractures from burst fractures and pathologic fractures. All compression rate measurements were performed with CT. The compression rate of the most affected vertebra (MAV-CR) was calculated. Groups were divided into two categories based on their compression rates: <50% and ≥50%. Initial PPN, PLR, NLR, and SII parameters were used as systemic inflammation scores. RESULTS: No statistically significant differences were found between MAV-CR groups in PPN, PLR, NLR, and SII parameters (p>0.05). No statistically significant correlation was observed between inflammation scores and MAV-CR groups (p>0.05). In this comparison, no significant difference was observed between the selected CBC parameters and the groups divided according to the compression rate (WBC: p=0.725, PC: p=0.069, NC: p=0.732, LC: p=0.513). ROC analysis was performed to analyze the diagnostic tests (AUC=0.372 for PPN, AUC=0.509 for PLR, AUC=0.525 for NLR, and AUC=0.435 for SII). None of the systemic inflammation scores had any predictive value for osteoporotic vertebral collapse fractures. CONCLUSIONS: Although it has been established in the scientific literature that systemic inflammation scores are associated with osteoporotic vertebral fractures, our analysis indicates no statistically significant correlation between the parameters of PPN, PLR, NLR, and SII and the severity of compression fractures in individuals with osteoporotic vertebral fractures. In this study, using systemic inflammation scores as a predictive test for the severity of osteoporotic vertebral fractures does not seem appropriate.