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World Neurosurgery May 2024To evaluate the risk factors of new osteoporotic vertebral compression fractures (OVCFs) after percutaneous vertebroplasty (PVP).
OBJECTIVE
To evaluate the risk factors of new osteoporotic vertebral compression fractures (OVCFs) after percutaneous vertebroplasty (PVP).
METHODS
From January 2016 to November 2019, patients suffering from OVCFs were retrospectively reviewed. The independent influence factors for new OVCFs after PVP were assessed, from following variables: age, sex, body mass index, bone mineral density (BMD), history of alcoholism, smoking, hypertension, diabetes, glucocorticoid use, and prior vertebral fractures, the number of initial fractures, mean cement volume, method of puncture, D-type of cement leakage, and regular antiosteoporosis treatment.
RESULTS
A total of 268 patients with 347 levels met the inclusion criteria and were finally included in this study. Forty-nine levels of new OVCFs among 33 patients (12.31%) were observed during the follow-up period. It indicated that female (adjusted odds ratio [OR]: 6.812, 95% confidence interval {CI}: [1.096, 42.337], P = 0.040), lower BMD (adjusted OR: 0.477, 95% CI: [0.300, 0.759], P = 0.002), prior vertebral fractures (adjusted OR: 16.145, 95% CI: [5.319, 49.005], P = 0.000), and regular antiosteoporosis treatment (adjusted OR: 0.258, 95% CI: [0.086, 0.774], P = 0.016) were independent influence factors for new OVCF. The cut-off value of BMD to reach new OVCF was -3.350, with a sensitivity of 0.660 and a specificity of 0.848.
CONCLUSION
Female, lower BMD (T-score of lumbar), prior vertebral fractures, and regular antiosteoporosis treatment were independent influencing factors. BMD (T-score of lumbar) lower than -3.350 would increase risk for new OVCF, and none osteoporotic treatment has detrimental effect on new onset fractures following PVP.
PubMed: 38734168
DOI: 10.1016/j.wneu.2024.05.007 -
International Journal of Molecular... May 2024Osteoporotic vertebral compression fractures (OVCFs) significantly increase morbidity and mortality, presenting a formidable challenge in healthcare. Traditional... (Review)
Review
Osteoporotic vertebral compression fractures (OVCFs) significantly increase morbidity and mortality, presenting a formidable challenge in healthcare. Traditional interventions such as vertebroplasty and kyphoplasty, despite their widespread use, are limited in addressing the secondary effects of vertebral fractures in adjacent areas and do not facilitate bone regeneration. This review paper explores the emerging domain of regenerative therapies, spotlighting stem cell therapy's transformative potential in OVCF treatment. It thoroughly describes the therapeutic possibilities and mechanisms of action of mesenchymal stem cells against OVCFs, relying on recent clinical trials and preclinical studies for efficacy assessment. Our findings reveal that stem cell therapy, particularly in combination with scaffolding materials, holds substantial promise for bone regeneration, spinal stability improvement, and pain mitigation. This integration of stem cell-based methods with conventional treatments may herald a new era in OVCF management, potentially improving patient outcomes. This review advocates for accelerated research and collaborative efforts to translate laboratory breakthroughs into clinical practice, emphasizing the revolutionary impact of regenerative therapies on OVCF management. In summary, this paper positions stem cell therapy at the forefront of innovation for OVCF treatment, stressing the importance of ongoing research and cross-disciplinary collaboration to unlock its full clinical potential.
Topics: Humans; Spinal Fractures; Fractures, Compression; Osteoporotic Fractures; Regenerative Medicine; Bone Regeneration; Animals; Stem Cell Transplantation; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells
PubMed: 38732198
DOI: 10.3390/ijms25094979 -
BMC Surgery May 2024The aim of this study was to develop and validate a machine learning (ML) model for predicting the risk of new osteoporotic vertebral compression fracture (OVCF) in...
PURPOSE
The aim of this study was to develop and validate a machine learning (ML) model for predicting the risk of new osteoporotic vertebral compression fracture (OVCF) in patients who underwent percutaneous vertebroplasty (PVP) and to create a user-friendly web-based calculator for clinical use.
METHODS
A retrospective analysis of patients undergoing percutaneous vertebroplasty: A retrospective analysis of patients treated with PVP between June 2016 and June 2018 at Liuzhou People's Hospital was performed. The independent variables of the model were screened using Boruta and modelled using 9 algorithms. Model performance was assessed using the area under the receiver operating characteristic curve (ROC_AUC), and clinical utility was assessed by clinical decision curve analysis (DCA). The best models were analysed for interpretability using SHapley Additive exPlanations (SHAP) and the models were deployed visually using a web calculator.
RESULTS
Training and test groups were split using time. The SVM model performed best in both the training group tenfold cross-validation (CV) and validation group AUC, with an AUC of 0.77. DCA showed that the model was beneficial to patients in both the training and test sets. A network calculator developed based on the SHAP-based SVM model can be used for clinical risk assessment ( https://nicolazhang.shinyapps.io/refracture_shap/ ).
CONCLUSIONS
The SVM-based ML model was effective in predicting the risk of new-onset OVCF after PVP, and the network calculator provides a practical tool for clinical decision-making. This study contributes to personalised care in spinal surgery.
Topics: Humans; Machine Learning; Retrospective Studies; Osteoporotic Fractures; Female; Aged; Male; Spinal Fractures; Risk Assessment; Vertebroplasty; Middle Aged; Internet; Fractures, Compression; Aged, 80 and over
PubMed: 38724895
DOI: 10.1186/s12893-024-02427-x -
Asian Journal of Surgery May 2024
PubMed: 38724383
DOI: 10.1016/j.asjsur.2024.04.202 -
Asian Journal of Surgery May 2024
PubMed: 38724367
DOI: 10.1016/j.asjsur.2024.04.169 -
Calcified Tissue International Jun 2024To construct a nomogram based on clinical factors and paraspinal muscle features to predict vertebral fractures occurring after acute osteoporotic vertebral compression...
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.
Topics: Humans; Spinal Fractures; Osteoporotic Fractures; Paraspinal Muscles; Female; Male; Aged; Retrospective Studies; Aged, 80 and over; Fractures, Compression; Middle Aged; Magnetic Resonance Imaging; Nomograms
PubMed: 38714533
DOI: 10.1007/s00223-024-01209-0 -
European Spine Journal : Official... May 2024To investigate the external validation and scalability of four predictive models regarding new vertebral fractures following percutaneous vertebroplasty.
OBJECTIVE
To investigate the external validation and scalability of four predictive models regarding new vertebral fractures following percutaneous vertebroplasty.
METHODS
Utilizing retrospective data acquired from two centers, compute the area under the curve (AUC), calibration curve, and Kaplan-Meier plot to assess the model's discrimination and calibration.
RESULTS
In the external validation of Zhong et al.'s 2015 predictive model for the probability of new fractures post-vertebroplasty, the AUC for re-fracture at 1, 2, and 3 years postoperatively was 0.570, 0.617, and 0.664, respectively. The AUC for Zhong et al.'s 2016 predictive model for the probability of new fractures in neighboring vertebrae was 0.738. Kaplan-Meier plot results for both models indicated a significantly lower incidence of re-fracture in low-risk patients compared to high-risk patients. Li et al.'s 2021 model had an AUC of 0.518, and its calibration curve suggested an overestimation of the probability of new fractures. Li et al.'s 2022 model had an AUC of 0.556, and its calibration curve suggested an underestimation of the probability of new fractures.
CONCLUSION
The external validation of four models demonstrated that the predictive model proposed by Zhong et al. in 2016 exhibited superior external generalization capabilities.
PubMed: 38713446
DOI: 10.1007/s00586-024-08274-x -
AME Case Reports 2024Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease, and one of the main complications of RA is osteoporosis, which can cause osteoporotic vertebral...
Spontaneous osteoporotic vertebral refractures after percutaneous vertebroplasty and kyphoplasty in a patient with rheumatoid arthritis: a case report and literature review.
BACKGROUND
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease, and one of the main complications of RA is osteoporosis, which can cause osteoporotic vertebral compression fractures (OVCFs) that lead to low back pain and spinal deformation. For RA patients with OVCFs, the symptoms of osteoporosis are more severe, if surgical treatment is to be carried out, it is important to focus on the treatment of osteoporosis caused by RA.
CASE DESCRIPTION
We report a case of a 68-year-old woman with RA and successional osteoporotic vertebral body fractures treated by percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). The patient experienced spontaneous multiple OVCFs on three occasions: in the course of 5 months, she underwent one PKP and two PVP operations with five cement-augmented vertebrae from the first to fifth lumbar vertebrae. The mean interval between each operation was 75 days (range, 2-3 months). The case report makes us look into the treatment of each stage and think about the reasons, we reviewed the literatures on advancements in the treatment of OVCFs caused by RA, so that we can choose a better method for similar patients in the future.
CONCLUSIONS
For OVCFs secondary to RA without neurological damage, if we carry out surgical treatment, the systematic treatments, including RA treatment, pain management, brace treatment, and anti-osteoporosis measures are important. among them, anti-osteoporosis treatment has the highest priority because of the reversible nature of osteoporosis caused by RA.
PubMed: 38711890
DOI: 10.21037/acr-23-112 -
European Heart Journal May 2024
PubMed: 38701007
DOI: 10.1093/eurheartj/ehae237 -
World Neurosurgery May 2024To investigate whether risk of new vertebral compression fractures (NVCFs) was associated with vicinity to treated vertebrae in percutaneous vertebroplasty (PVP) for...
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.
PubMed: 38697261
DOI: 10.1016/j.wneu.2024.04.162