Prediction of incident vertebral fracture using CT-based finite element analysis

Allaire, Brett T.; Lu, Darlene; Jóhannesdóttir, Fjóla; Kopperdahl, David L.; Keaveny, Tony M.; Jarraya, Mohamed; Guermazi, Ali; Bredella, Miriam A.; Samelson, Elizabeth J.; Kiel, Douglas P.; Anderson, Dennis E.; Demissie, Serkalem; Bouxsein, Mary L.

doi:10.1007/s00198-018-4716-1

Cited by 68 publications

(70 citation statements)

References 42 publications

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“…FEA is a validated engineering technique that has been successfully employed to asses bone strength in the hips and spine. [51][52][53][54] It already has been reported to be superior to DXA scans in predicting fragility fractures at the hip and spine, 53,[55][56][57][58][59][60][61][62][63] and could provide further insight into the diagnosis and risk stratification of osteoporotic patients prior to undergoing surgical procedures of the spine. While oCT is an enticing diagnostic test, it is still limited in its sensitivity and specificity to be used as a diagnostic tool.…”

Section: Resultsmentioning

confidence: 99%

Opportunistic Computed Tomography and Spine Surgery: A Narrative Review

Shirley

Wanderman

Keaveny

et al. 2019

Global Spine Journal

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Study Design: Narrative review. Objective: This article seeks to provide a narrative review regarding the ability of opportunistic information available from computed tomography (CT) scans to guide decisions in spine surgery related to patient bone quality. Methods: A review of the literature (limited to human and English language) was performed via PubMed and Google Scholar using the search terms; “osteoporosis” AND “opportunistic” AND “computed tomography” AND “spine surgery.” The titles and then abstracts of all identified citations were reviewed for inclusion by 2 of the authors (MS, BAF). Relevant articles were then studied in full text. Results: A review of the literature found 25 articles that were selected for inclusion in this narrative review. These articles were broadly divided into 4 subcategories: (1) opportunistic CT (oCT) and osteoporosis detection, (2) oCT data and the quality of screw fixation, (3) utilization of Hounsfield units to assess clinical and/or radiographic outcomes following spine fusion, and (4) virtual stress testing in spine surgery. Conclusion: The literature on oCT, as well as associated virtual stress-testing techniques, demonstrate the potential to enhance spine surgery outcomes by preoperatively identifying at-risk patients in need of bone health optimization and informing best techniques for performing spinal fusion surgery on patients with diminished bone quality. While our narrative summary of the limited literature to date suggests a promising future for oCT data, significant additional research and/or radiographic workflow standardization is needed to validate these methods for clinical use.

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Section: Resultsmentioning

confidence: 99%

Opportunistic Computed Tomography and Spine Surgery: A Narrative Review

Shirley

Wanderman

Keaveny

et al. 2019

Global Spine Journal

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“…The bone is then isolated from the surrounding tissues and organs (posterior elements are virtually removed for the spine) using advanced image processing. Unlike with spinal DXA for which four vertebral levels are typically assessed, analysis of just one [33,34] or two [35] vertebral levels (between T12 and L3) by BCT has been shown to be effective for spinal fracture prediction; similarly, analysis of just one femur is adequate for hip fracture prediction [16,20,35]. To provide a patientspecific calibration and therefore enable a diagnostic-quality measurement of BMD, the CT scan is calibrated using either an external calibration phantom (typical in research studies) or a phantomless approach (typical in clinical practice) using internal tissues as references (details below).…”

Section: Details Of the (Virtuost) Bct Testmentioning

confidence: 99%

“…The correlation between BCT and DXA (center) was similar to that between left and right hip for DXA (right) and over twofold higher than between hip and spine for DXA (left). From Fidler [47] standard deviation for vertebral fracture were consistently higher for vertebral trabecular BMD than for spinal DXA BMD, both for prevalent fracture-1.9 vs. 0.7 [62]; 1.9 vs. 1.3 [63]; 3.4 vs. 1.9 [64]-and for incident fracture-5.7 vs. 3.2 [33]; 2.4 vs. 1.8 [34]. Limited comparative data exist on sensitivity and specificity for predicting new vertebral fractures by vertebral trabecular BMD versus spinal DXA BMD.…”

Section: Clinical Efficacy and Validationmentioning

confidence: 99%

“…Limited comparative data exist on sensitivity and specificity for predicting new vertebral fractures by vertebral trabecular BMD versus spinal DXA BMD. As discussed below, the available comparative data [33][34][35] suggest that the sensitivity for vertebral trabecular BMD at the ACR-recommended (American College of Radiology) cut-point of 80 mg/cm 3 is higher than for spinal DXA BMD T-score at the traditional T ≤ − 2.5 cut-point, although specificity can be lower for BCT. Other groups previously validated vertebral trabecular BMD from quantitative CT for vertebral fracture risk assessment [61].…”

Section: Clinical Efficacy and Validationmentioning

confidence: 99%

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Biomechanical Computed Tomography analysis (BCT) for clinical assessment of osteoporosis

et al. 2020

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The surgeon general of the USA defines osteoporosis as "a skeletal disorder characterized by compromised bone strength, predisposing to an increased risk of fracture." Measuring bone strength, Biomechanical Computed Tomography analysis (BCT), namely, finite element analysis of a patient's clinical-resolution computed tomography (CT) scan, is now available in the USA as a Medicare screening benefit for osteoporosis diagnostic testing. Helping to address under-diagnosis of osteoporosis, BCT can be applied "opportunistically" to most existing CT scans that include the spine or hip regions and were previously obtained for an unrelated medical indication. For the BCT test, no modifications are required to standard clinical CT imaging protocols. The analysis provides measurements of bone strength as well as a dual-energy X-ray absorptiometry (DXA)equivalent bone mineral density (BMD) T-score at the hip and a volumetric BMD of trabecular bone at the spine. Based on both the bone strength and BMD measurements, a physician can identify osteoporosis and assess fracture risk (high, increased, not increased), without needing confirmation by DXA. To help introduce BCT to clinicians and health care professionals, we describe in this review the currently available clinical implementation of the test (VirtuOst), its application for managing patients, and the underlying supporting evidence; we also discuss its main limitations and how its results can be interpreted clinically. Together, this body of evidence supports BCT as an accurate and convenient diagnostic test for osteoporosis in both sexes, particularly when used opportunistically for patients already with CT.

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“…The mesh model generated in SolidWorks 2017CAD was imported into ANSYS Workbench 17.0 (ANSYS, Ltd., Canonsburg, PA, USA), and previous literature was referenced to set the cortical bone (osteoporosis), cancellous bone (osteoporosis), articular cartilage, endplates, annulus fibrosus, nucleus pulposus, bone cement, cages, and internal fixation ( Table 1). The ligaments were simulated using spring elements that were only stressed by pulling force (one ligament stimulated by one spring) [17][18][19][20]. The contact type between the models was defined in the connection, where in the facet joint contact type was frictional and the frictional coefficient was 0.2 [21]; the remaining contact types were set to be the bonded mode [20,22].…”

Section: Materials Properties and Biomechanical Evaluationmentioning

confidence: 99%

Influence of cement-augmented pedicle screw instrumentation in an osteoporotic lumbosacral spine over the adjacent segments: a 3D finite element study

Zhou

Zeng

et al. 2020

J Orthop Surg Res

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To compare the effect of conventional pedicle screw (CPS) and cement-augmented pedicle screw instrumentation (CAPSI) on adjacent segment degeneration (ASD). Methods: A normal male volunteer without a history of spinal disease was selected, lumbar CT data was collected, an intact L3-S1 three-dimensional finite element model was created by software including Mimics, Geomagic, and SolidWorks, and the fixation methods were performed accordingly. A common pedicle screw model and a cementaugmented pedicle screw model of L4-L5 with fusion and internal fixation were constructed. With ANSYS Workbench 17.0, a 500 N load was applied to the upper surface of L3 to simulate the weight of a human body, and a 7.5 N m moment was applied at the neutral point to simulate flexion, extension, left/right bending, left/right rotation of the spine. The peak von Mises stress of intervertebral disc and the range of motion (ROM) on the adjacent segments (L3-4 and L5-S1) were compared. Results: The validity of the intact model shows that the ROM of the model is similar to that of a cadaveric study. Compared with the intact model, CPS model and CAPSI model in all motion patterns increased the ROM of adjacent segments. The intervertebral disc stress and the ROM of adjacent segments were found to be higher in the CAPSI model than in the CPS model, especially in L3-4. Conclusion: In general, the biomechanical analysis of an osteoporotic lumbar spine showed that both CPS and CAPSI can increase the ROM and disc stresses of osteoporotic lumbar models, and compared with CPS, CAPSI is more likely to increase the potential risk of adjacent segment degeneration.

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Prediction of incident vertebral fracture using CT-based finite element analysis

Cited by 68 publications

References 42 publications

Opportunistic Computed Tomography and Spine Surgery: A Narrative Review

Opportunistic Computed Tomography and Spine Surgery: A Narrative Review

Biomechanical Computed Tomography analysis (BCT) for clinical assessment of osteoporosis

Influence of cement-augmented pedicle screw instrumentation in an osteoporotic lumbosacral spine over the adjacent segments: a 3D finite element study

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