Division of Endocrinology, Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America.
Department of Materials Science and Engineering, Cornell University, Ithaca, NY, United States of America.
Bone. 2023 Apr;169:116678. doi: 10.1016/j.bone.2023.116678. Epub 2023 Jan 14.
Spine fusion surgery is one of the most common orthopedic procedures, with over 400,000 performed annually to correct deformities and pain. However, complications occur in approximately one third of cases. While many of these complications may be related to poor bone quality, it is difficult to detect bone abnormalities prior to surgery. Areal BMD (aBMD) assessed by DXA may be artifactually high in patients with spine pathology, leading to missed diagnosis of deficits. In this study, we related preoperative imaging characteristics of both central and peripheral sites to direct measurements of bone quality in vertebral biopsies. We hypothesized that pre-operative imaging outcomes would relate to vertebral bone mineralization and collagen properties. Pre-operative assessments included DXA measurements of aBMD of the spine, hip, and forearm, central quantitative computed tomography (QCT) of volumetric BMD (vBMD) at the lumbar spine, and high resolution peripheral quantitative computed tomography (HRpQCT; Xtreme CT2) measurements of vBMD and microarchitecture at the distal radius and tibia. Bone samples were collected intraoperatively from the lumbar vertebrae and analyzed using Fourier-transform Infrared (FTIR) spectroscopy. Bone samples were obtained from 23 postmenopausal women (mean age 67 ± 7 years, BMI 28 ± 8 kg/m). We found that patients with more mature bone by FTIR, measured as lower acid phosphate content and carbonate to phosphate ratio, and greater collagen maturity and mineral maturity/crystallinity (MMC), had greater cortical vBMD at the tibia and greater aBMD at the lumbar spine and one-third radius. Our data suggests that bone quality at peripheral sites may predict bone quality at the spine. As bone quality at the spine is challenging to assess prior to surgery, there is a great need for additional screening tools. Pre-operative peripheral bone imaging may provide important insight into vertebral bone quality and may foster identification of patients with bone quality deficits.
脊柱融合手术是最常见的矫形手术之一，每年约有 40 多万例手术用于矫正畸形和疼痛。然而，大约三分之一的病例会出现并发症。虽然这些并发症中的许多可能与骨质量差有关，但在手术前很难检测到骨异常。通过 DXA 评估的面积骨密度 (aBMD) 在患有脊柱疾病的患者中可能会人为升高，导致骨量不足的诊断被遗漏。在这项研究中，我们将术前中央和外周部位的影像学特征与椎体活检的直接骨质量测量相关联。我们假设术前影像学结果与椎体骨矿化和胶原特性有关。术前评估包括脊柱、髋部和前臂的 DXA 测量 aBMD，腰椎中央定量 CT (QCT) 测量容积骨密度 (vBMD)，以及远端桡骨和胫骨的高分辨率外周定量 CT (HRpQCT; Xtreme CT2) 测量 vBMD 和微结构。术中从腰椎采集骨样本，并使用傅里叶变换红外 (FTIR) 光谱进行分析。从 23 名绝经后妇女 (平均年龄 67 ± 7 岁，BMI 28 ± 8 kg/m) 中获得骨样本。我们发现，通过 FTIR 测量的具有更低的酸性磷酸酯含量和碳酸根/磷酸根比值、更高的胶原成熟度和矿化成熟度/结晶度 (MMC) 的患者，其胫骨皮质 vBMD 更高，腰椎和三分之一半径的 aBMD 更高。我们的数据表明，外周部位的骨质量可能预测脊柱的骨质量。由于脊柱骨质量在手术前难以评估，因此非常需要额外的筛查工具。术前外周骨成像可能为脊柱骨质量提供重要的见解，并有助于识别骨质量不足的患者。
