Lang Siegmund, Bachtler Michael, Straub Josina, Krückel Jonas, Baertl Susanne, Ardelt Melanie, Napodano Gerardo, Haimerl Michael, Loibl Markus, Alt Volker, Kerschbaum Maximilian
Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany.
Department of Orthopaedics and Trauma Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria.
Eur Spine J. 2025 Jul 26. doi: 10.1007/s00586-025-09163-7.
Pyogenic vertebral osteomyelitis (PVO) presents an escalating clinical challenge due to rising incidence, high mortality, and significant bone destruction. Objective quantification of vertebral body (VB) bone loss for assessing the disease severity and guiding therapeutic decisions is yet to be established.
We retrospectively identified patients with confirmed PVO between 2010 and 2020. Volumetric assessments of VBs were performed using 3D Slicer, and pre-infection volumes were estimated by linear regression based on adjacent, non-infected vertebrae. A "Destruction Quotient" (DQ) was calculated (measured volume/estimated original volume) to quantify VB loss. In a subgroup analysis VB bone loss was evaluated, depending on sex, spinal location and pathogen group.
Thirty-one patients met the inclusion criteria for 3D volumetry (16 males, 15 females; mean age: 67.0 ± 9.2 years; mean BMI 32.4 kg/m²). In total, n = 267 VBs were segmented. Linear regression models demonstrated a high mean coefficient of determination (R²>0.95), with mean slopes of m = 2.3 (95% CI = 1.94-2.75) in males and m = 1.8 (95% CI = 1.46-2.19) in females. The mean measured volume of infected VBs (17.8 ± 9.3 cm³) was significantly lower than the estimated original volume (24.1 ± 10.5 cm³; p < 0.001). VBs at the lumbar spine experienced a median volume loss of 30%, whereas thoracic VBs showed 18% loss of volume. Female patients demonstrated a significantly higher median VB loss (32%) than males (12%; p < 0.05). No significant variation in DQs was observed among different pathogen groups, with Staphylococcus aureus being the most prevalent; however, within the Staphylococcus aureus subgroup, the measured VB volume was significantly smaller than the original estimated volume with a mean difference of 6.13 ± 4.9 cm (p < 0.01).
A 3D-volumetric approach and linear regression modeling offers an individualized method for quantifying VB destruction in PVO. Integrating automated segmentation and densitometric data may further enhance predictive accuracy and improve patient-specific treatment strategies.
由于发病率上升、死亡率高以及严重的骨质破坏，化脓性脊椎骨髓炎（PVO）带来了日益严峻的临床挑战。目前尚未建立用于评估疾病严重程度和指导治疗决策的椎体（VB）骨丢失客观量化方法。
我们回顾性确定了2010年至2020年间确诊为PVO的患者。使用3D Slicer对椎体进行容积评估，并根据相邻未感染椎体通过线性回归估计感染前的容积。计算“破坏商”（DQ）（测量容积/估计原始容积）以量化椎体丢失。在亚组分析中，根据性别、脊柱位置和病原体组评估椎体骨丢失情况。
31例患者符合3D容积测量的纳入标准（16例男性，15例女性；平均年龄：67.0±9.2岁；平均BMI 32.4kg/m²）。总共分割了n = 267个椎体。线性回归模型显示平均决定系数较高（R²>0.95），男性的平均斜率m = 2.3（95%CI = 1.94 - 2.75），女性的平均斜率m = 1.8（95%CI = 1.46 - 2.19）。感染椎体的平均测量容积（17.8±9.3cm³）显著低于估计的原始容积（24.1±10.5cm³；p < 0.001）。腰椎椎体的中位容积丢失为30%，而胸椎椎体的容积丢失为18%。女性患者的椎体中位丢失（32%）显著高于男性（12%；p < 0.05）。不同病原体组之间的DQ未观察到显著差异，金黄色葡萄球菌最为常见；然而，在金黄色葡萄球菌亚组中，测量的椎体容积显著小于原始估计容积，平均差异为6.13±4.9cm（p < 0.01）。
3D容积测量方法和线性回归建模为量化PVO中的椎体破坏提供了一种个体化方法。整合自动分割和密度测量数据可能进一步提高预测准确性并改善针对患者的治疗策略。
