Influence of non-traumatic thoracic and lumbar vertebral fractures on sagittal spine alignment assessed by radiation-free spinometry
Influence of non-traumatic thoracic and lumbar vertebral fractures on sagittal spine alignment assessed by radiation-free spinometry
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DOI：
10.1007/s00198-012-2156-x
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发表时间：
2013-06
影响因子：
4
通讯作者：
M. Krause;S. Breer;B. Mohrmann;E. Vettorazzi;R. Marshall;M. Amling;F. Barvencik
中科院分区：
文献类型：
--
作者：
M. Krause;S. Breer;B. Mohrmann;E. Vettorazzi;R. Marshall;M. Amling;F. Barvencik
由于缺乏特定诊断的适应症，大多数无症状的椎体骨折未被诊断。本研究显示无辐射脊柱测量法评估矢状椎参数的能力，以提高对新的非创伤性胸椎和腰椎骨折的怀疑，并指出具体的诊断。本研究的主要目的是通过评估胸后凸（TK）、腰椎前凸（LL）和躯干倾斜来研究无辐射脊柱测量法预测新的非创伤性椎体骨折（VF）的准确性。方法共纳入361例患者，其中女性278例，男性83例，年龄67.0±8.6岁。在86名女性和24名男性中，至少有1例非创伤性VF通过x线摄影、MRI和/或CT确诊。脊柱测量（视频光栅立体成像）用于评估TK、LL和躯干倾斜度。采用受试者工作特征（ROC）和多变量logistic回归分析来检验年龄、性别、骨折数量、骨折位置和骨折等级对矢状位脊柱排列的影响。结果stk、LL、躯干倾斜度与年龄增长相关（p< 0.05）。与无VFs的患者相比，胸椎和腰椎VFs患者的TK增加（p< 0.001）， LL降低（p< 0.001），躯干倾斜度增加（p< 0.001）。ROC分析显示，联合TK和LL对胸椎和腰椎新发2级或3级VFs的预测准确性最好（AUC, 0.752-0.771）。优势比（OR）显示，在特定的感兴趣区域，TK （OR, 1.05-1.11, p< 0.001）和LL （1.05-1.07, p< 0.001）增加的VFs风险增加。TK <50°（敏感性88 - 100%；特异性23 - 25%）和LL（78 - 92%; 24 - 27%）被认为是未来筛查的适当截止点。结论脊柱测量比历史身高损失具有更好的预测准确性。TK和LL的严重变化可能有助于提高对无辐射的新VFs的怀疑，并提示适当的诊断，如x线摄影、MRI或CT。
SummaryDue to missing indications for specific diagnostics, the majority of non-symptomatic vertebral fractures are not diagnosed. This study shows the ability of radiation-free spinometry to assess sagittal spine parameters to raise suspicion for new non-traumatic thoracic and lumbar vertebral fractures and indicate specific diagnostics.IntroductionThe primary aim of this study was to investigate the accuracy of radiation-free spinometry to predict new non-traumatic vertebral fractures (VF) by the assessment of thoracic kyphosis (TK), lumbar lordosis (LL), and trunk inclination.MethodsThree hundred sixty-one patients (278 females and 83 males; age, 67.0 ± 8.6 years) were enrolled. In 86 women and 24 men, at least one non-traumatic VF was confirmed by radiography, MRI, and/or CT. Spinometry (video rasterstereography) was used to assess TK, LL, and trunk inclination. Receiver operating characteristic (ROC) and multivariate logistic regression analyses were performed to test the influence of age, sex, number, location, and grade of fractures on sagittal spine alignment.ResultsTK, LL, and trunk inclination were associated with advancing age (p< 0.05). Patients with prevalent thoracic and lumbar VFs showed increased TK (p< 0.001), decreased LL (p< 0.001), and increased trunk inclination (p< 0.001) in comparison to patients without VFs. ROC analysis revealed that the combination of TK and LL presented with the best predictive accuracy to raise suspicion for new grade 2 or grade 3 VFs in the thoracic and the lumbar spine (AUC, 0.752–0.771). Odds ratio (OR) showed an increased risk for VFs with increased TK (OR, 1.05–1.11;p< 0.001) and LL (1.05–1.07;p< 0.001) in specified regions of interest. A TK <50° (sensitivity, 88–100 %; specificity, 23–25 %) and LL (78–92 %; 24–27 %) were considered as appropriate cutoffs for future screening.ConclusionSpinometry showed better predictive accuracy than historical height loss. Severe changes of TK and LL may help to raise suspicion of new VFs radiation-free and indicate proper diagnostics, such as radiographs, MRI, or CT.