Osteoporosis in acute fractures of the cervical spine: the role of opportunistic CT screening

Emohare, Osa; Dittmer, A.; Morgan, Robert; Switzer, Julie A.; Polly, David W.

doi:10.3171/2014.10.spine14233

Cited by 44 publications

(35 citation statements)

References 33 publications

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“…This hypothesis is supported further as qualitatively assessed bone mineral density (BMD) was reported to be lower in patients with TOFs than in those without . Additionally, a recent study has suggested that the prevalence of osteoporosis and osteopenia in odontoid fracture patients is relatively high …”

Section: Introductionmentioning

confidence: 77%

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Osteoporosis Is the Most Important Risk Factor for Odontoid Fractures in the Elderly

Kaesmacher

Schweizer

Valentinitsch

et al. 2017

Journal of Bone and Mineral Research

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Traumatic odontoid fractures (TOFs) have been described as the most common injury affecting the C-spine in the elderly. Previous studies have identified degenerative changes and bone loss as important predisposing factors. However, their interaction and respective age-adjusted impact needs further clarification. We conducted a retrospective analysis of 5303 patients (aged ≥60 years) admitted to a level I trauma center between January 2008 and January 2016 who underwent CT imaging of the C-spine. Ninety-two patients with TOF and 80 patients with other cervical spine fractures (OCSF) were identified and a respective 3:1 age- and sex-matched control group without fractures after trauma was built. In all groups, cervical bone mineral density (cBMD) was determined using phantom calibration, and degenerative changes were evaluated in a qualitative manner. In all groups, the severity of degenerative changes of the C-spine increased with age (all p < 0.05) and was inversely correlated with cBMD (all p < 0.05). cBMD was the only significant predictor of a TOF in a multivariate logistic regression model (adjusted odds ratio [OR] = 3.066, 95% confidence interval [CI] 1.432-6.563 for cervical osteoporosis). An association between odontoid cysts and TOF reached significance only in Anderson and D'Alonzo (A&D) type II TOFs (aOR = 1.383; 95% CI 1.012-1.890). Patients with OCSFs, compared with patients with TOFs, were younger (median 74 versus 83 years) and had a higher cBMD (median 208 mg/mL versus 172 mg/mL). No differences were observable when comparing cBMD and grades of degenerative changes between OCSFs and their control group (all p >0.1). Decreased cBMD is the major predisposing factor for the occurrence of TOF but not for OCSF in the elderly. The severity of odontoid cysts was found to be a cBMD-independent factor associated with A&D type II TOFs. However, degenerative changes in the odontoid neighboring joints seem to be an epiphenomenon of bone loss and older age but do not independently predispose for TOF. © 2017 American Society for Bone and Mineral Research.

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Section: Introductionmentioning

confidence: 77%

“…Several studies have shown that low bone quality is associated with an increased risk for odontoid fractures . Until now, a quantitatively and phantom‐calibrated measurement method assessing bone quality in TOFs and respective controls were lacking.…”

Section: Discussionmentioning

confidence: 99%

Osteoporosis Is the Most Important Risk Factor for Odontoid Fractures in the Elderly

Kaesmacher

Schweizer

Valentinitsch

et al. 2017

Journal of Bone and Mineral Research

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“…Differences in BMD values measured by DEXA and QCT are widely recognized (20262728). The reason is possibly related to different bone turnover between the cancellous and the cortical bone.…”

Section: Discussionmentioning

confidence: 99%

Population-Stratified Analysis of Bone Mineral Density Distribution in Cervical and Lumbar Vertebrae of Chinese from Quantitative Computed Tomography

Zhang

Zhou

et al. 2016

Korean J Radiol

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ObjectiveTo investigate the bone mineral density (BMD) of cervical vertebrae in a population-stratified manner and correlate with that of the lumbar vertebrae.Materials and MethodsFive hundred and ninety-eight healthy volunteers (254 males, 344 females), ranging from 20 to 64 years of age, were recruited for volumetric BMD (vBMD) measurements by quantitative computed tomography. Basic information (age, height, weight, waistline, and hipline), and vBMD of the cervical and lumbar vertebrae (C2–7 and L2–4) were recorded. Comparisons among sex, age groups and different levels of vertebrae were analyzed using analysis of variance. Linear regression was performed for relevance of different vertebral levels.ResultsThe vBMD of cervical and lumbar vertebrae was higher in females than males in each age group. The vBMD of the cervical and lumbar vertebrae in males and the vBMD of lumbar vertebrae in females decreased with aging. In each age group, the vBMD of the cervical vertebrae was higher than that of the lumbar vertebrae with gradual decreases from C2 to C7 except for C3; moreover, the vBMD of C6 and C7 was significantly different from that of C2–5. Correlations of vBMD among different cervical vertebrae (females: r = 0.62–0.94; males: r = 0.63–0.94) and lumbar vertebrae (males: r = 0.93–0.98; females: r = 0.82–0.97) were statistically significant at each age group.ConclusionThe present study provided normative data of cervical vertebrae in an age- and sex-stratified manner. Sex differences in vBMD prominently vary with age, which can be helpful to design a more comprehensive pre-operative surgical plan.

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“…Three studies examined standard surgical intervention before radiotherapy, whereas one recent study evaluated laser interstitial thermotherapy (LITT). 39 Three studies had long-term follow-up, except the LITT study that reported perioperative outcomes with a short median follow-up time of 4.7 months. The mean local failure rate was 17.1% with a mean time to local recurrence of 13.6 months.…”

Section: Resultsmentioning

confidence: 99%

“…Complications were minimal in all four studies and included hardware failure in a selected group of patients, only some of which required reoperation. 37,39–41 Of note, some patients developed toxicity because of SRS, which included GI, GU, and musculoskeletal manifestations. 40 …”

Section: Resultsmentioning

confidence: 99%

When Less Is More

Zuckerman

Laufer

Sahgal

et al. 2016

Spine

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Study Design Systematic review. Objective The aim of this study was to review the techniques, indications, and outcomes of minimally invasive surgery (MIS) and separation surgery with subsequent radiosurgery in the treatment of patients with metastatic spine disease. Summary of Background Data The utilization of MIS techniques in patients with spine metastases is a growing area within spinal oncology. Separation surgery represents a novel paradigm where radiosurgery provides long-term control after tumor is surgically separated from the neural elements. Methods PubMed, Embase, and CINAHL databases were systematically queried for literature reporting MIS techniques or separation surgery in patients with metastatic spine disease. PRISMA guidelines were followed. Results Of the initial 983 articles found, 29 met inclusion criteria. Twenty-five articles discussed MIS techniques and were grouped according to the primary objective: percutaneous stabilization (8), tubular retractors (4), mini-open approach (8), and thoracoscopy/endoscopy (5). The remaining 4 studies reported separation surgery. Indications were similar across all studies and included patients with instability, refractory pain, or neurologic compromise. Intraoperative variables, outcomes, and complications were similar in MIS studies compared to traditional approaches, and some MIS studies showed a statistically significant improvement in outcomes. Studies of mini-open techniques had the strongest evidence for superiority. Conclusions Low-quality evidence currently exists for MIS techniques and separation surgery in the treatment of metastatic spine disease. Given the early promising results, the next iteration of research should include higher-quality studies with sufficient power, and will be able to provide higher-level evidence on the outcomes of MIS approaches and separation surgery.

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Osteoporosis in acute fractures of the cervical spine: the role of opportunistic CT screening

Cited by 44 publications

References 33 publications

Osteoporosis Is the Most Important Risk Factor for Odontoid Fractures in the Elderly

Osteoporosis Is the Most Important Risk Factor for Odontoid Fractures in the Elderly

Population-Stratified Analysis of Bone Mineral Density Distribution in Cervical and Lumbar Vertebrae of Chinese from Quantitative Computed Tomography

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