Osteoporotic and Neoplastic Compression Fracture Classification on Longitudinal CT

Classification of vertebral compression fractures (VCF) having osteoporotic or neoplastic origin is fundamental to the planning of treatment. We developed a fracture classification system by acquiring quantitative morphologic and bone density determinants of fracture progression through the use of automated measurements from longitudinal studies. A total of 250 CT studies were acquired for the task, each having previously identified VCFs with osteoporosis or neoplasm. Thirty-six features or each identified VCF were computed and classified using a committee of support vector machines. Ten-fold cross validation on 695 identified fractured vertebrae showed classification accuracies of 0.812, 0.665, and 0.820 for the measured, longitudinal, and combined feature sets respectively.Comment: Contributed 4-Page Paper to be presented at the 2016 IEEE International Symposium on Biomedical Imaging (ISBI), April 13-16, 2016, Prague, Czech Republi

Biomechanical Tolerance of Whole Lumbar Spines in Straightened Posture Subjected to Axial Acceleration

Quantification of biomechanical tolerance is necessary for injury prediction and protection of vehicular occupants. This study experimentally quantified lumbar spine axial tolerance during accelerative environments simulating a variety of military and civilian scenarios. Intact human lumbar spines (T12‐L5) were dynamically loaded using a custom‐built drop tower. Twenty‐three specimens were tested at sub‐failure and failure levels consisting of peak axial forces between 2.6 and 7.9 kN and corresponding peak accelerations between 7 and 57 g. Military aircraft ejection and helicopter crashes fall within these high axial acceleration ranges. Testing was stopped following injury detection. Both peak force and acceleration were significant (p \u3c 0.0001) injury predictors. Injury probability curves using parametric survival analysis were created for peak acceleration and peak force. Fifty‐percent probability of injury (95%CI) for force and acceleration were 4.5 (3.9–5.2 kN), and 16 (13–19 g). A majority of injuries affected the L1 spinal level. Peak axial forces and accelerations were greater for specimens that sustained multiple injuries or injuries at L2–L5 spinal levels. In general, force‐based tolerance was consistent with previous shorter‐segment lumbar spine testing (3–5 vertebrae), although studies incorporating isolated vertebral bodies reported higher tolerance attributable to a different injury mechanism involving structural failure of the cortical shell. This study identified novel outcomes with regard to injury patterns, wherein more violent exposures produced more injuries in the caudal lumbar spine. This caudal migration was likely attributable to increased injury tolerance at lower lumbar spinal levels and a faster inertial mass recruitment process for high rate load application. Published 2017. This article is a U.S. Government work and is in the public domain in the USA

Performance of a deep convolutional neural network for MRI-based vertebral body measurements and insufficiency fracture detection

OBJECTIVES The aim is to validate the performance of a deep convolutional neural network (DCNN) for vertebral body measurements and insufficiency fracture detection on lumbar spine MRI. METHODS This retrospective analysis included 1000 vertebral bodies in 200 patients (age 75.2 ± 9.8 years) who underwent lumbar spine MRI at multiple institutions. 160/200 patients had ≥ one vertebral body insufficiency fracture, 40/200 had no fracture. The performance of the DCNN and that of two fellowship-trained musculoskeletal radiologists in vertebral body measurements (anterior/posterior height, extent of endplate concavity, vertebral angle) and evaluation for insufficiency fractures were compared. Statistics included (a) interobserver reliability metrics using intraclass correlation coefficient (ICC), kappa statistics, and Bland-Altman analysis, and (b) diagnostic performance metrics (sensitivity, specificity, accuracy). A statistically significant difference was accepted if the 95% confidence intervals did not overlap. RESULTS The inter-reader agreement between radiologists and the DCNN was excellent for vertebral body measurements, with ICC values of > 0.94 for anterior and posterior vertebral height and vertebral angle, and good to excellent for superior and inferior endplate concavity with ICC values of 0.79-0.85. The performance of the DCNN in fracture detection yielded a sensitivity of 0.941 (0.903-0.968), specificity of 0.969 (0.954-0.980), and accuracy of 0.962 (0.948-0.973). The diagnostic performance of the DCNN was independent of the radiological institution (accuracy 0.964 vs. 0.960), type of MRI scanner (accuracy 0.957 vs. 0.964), and magnetic field strength (accuracy 0.966 vs. 0.957). CONCLUSIONS A DCNN can achieve high diagnostic performance in vertebral body measurements and insufficiency fracture detection on heterogeneous lumbar spine MRI. KEY POINTS • A DCNN has the potential for high diagnostic performance in measuring vertebral bodies and detecting insufficiency fractures of the lumbar spine

Diagnosis particularities of spinal injuries in polytrauma

Spinal injuries occur frequently in the patient with polytrauma making the knowledge of the evaluation and treatment of these injuries invaluable to the trauma team. In the immediate moments after these injuries, critical steps can be taken to prevent additional injury and insure maximum neurologic and functional recovery of the patient. A simple, standardized approach to treating the patient at the scene, examining the patient in the trauma admitting area, ordering appropriate radiographic studies, and instituting early treatment can markedly influence a patient’s maximal recovery

Intra-spinal epidural leakage of bone cement during vertebroplasty of an osteoporotic vertebral fracture: case report and review of literature

Vertebral fractures are one of the most common complications of osteoporosis. Prolonged and intractable pain leads to immobilization and significant morbidity. Vertebroplasty is designed primarily to relieve pain, and the procedure is considered when osteoporotic vertebral fracture does not respond to a reasonable period of conservative care. Vertebroplasty has a low complication rate with most common complication being adjacent vertebral body fracture and rare complication due to extra-vertebral cement leakage causing nerve root compression or pulmonary embolism. We report a case of 55 year old lady with osteoporotic D12 wedge compression fracture subjected to vertebroplasty resulting in intraspinal cement leakage noticed intra-operatively. Patient underwent immediate decompression, cement extraction and posterior instrumentation. Postoperative course was uneventful

CT-Guided Percutaneous Vertebroplasty in the Treatment of an Upper Thoracic Compression Fracture

Percutaneous vertebroplasty (PVP) has been used to relieve pain and to prevent further collapse of the vertebral body in patients with an osteoporotic compression fracture. The most commonly affected site for the use of PVP is the thoracolumbar junction. There are few reports that have described on the usefulness of PVP in the treatment of a high thoracic compression fracture. We report a case of an upper thoracic compression fracture that was treated with computed tomography (CT)-guided PVP. It was possible to obtain easy access to the narrow thoracic pedicle and it was also possible to monitor continuously the proper volume of polymethylmethacrylate employed, under CT guidance