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Background The purpose of this study was to use MRI and CT to observe osteoporosis vertebral fracture (OVF) combined with endplate-disc complex (EDC) injury and to classify the degree of EDC injury according to the changes in EDC signal intensity and morphology on the images. Methods We investigated the incidence of EDC injury, observed the morphology and signal intensity changes of EDC injury using MRI and CT, and graded the injuries from 0 to 4 according to their severity. We compared whether there were differences in the degree of EDC injury among different vertebral fractures, bone mineral density(BMD), and severity of vertebral fractures. Results A total of 479 patients were included in this study, of whom 321 had EDC injury adjacent to the fractured vertebral body. Among those, 158 cases were grade 0, 66 cases were grade 1, 72 cases were grade 2, 78 cases were grade 3, and 92 cases were grade 4. The degree of EDC injury associated with thoracolumbar vertebral fractures was more serious than that of EDC injuries associated with thoracic and lumbar vertebral body fractures. Vertebral fractures with severe osteoporosis were associated with more severe EDC injury. Additionally, the more severe the vertebral fracture, the more severe was the combined EDC injury. Conclusion This study found that the incidence rate of EDC injury reached 67.0%. Among patients with OVF, severe osteoporosis and severe fractures in the thoracolumbar segments were often associated with more severe EDC injury.

Chordomas are rare primary bone malignancies derived from notochord remnants. The tumors often are slow-growing and often present with indolent, nonspecific symptoms. Nevertheless, chordomas are locally aggressive and highly prone to local recurrence, necessitating precise planning before biopsy and/or surgical resection. Familiarity with the imaging features of chordomas is, therefore, essential. This case highlights the typical imaging and pathologic features of a spinal chordoma as well as the surgical approach and the patient’s subsequent outcome.

The lumbar area of human spine is the commonest site of low backache. Knowledge of lumbar morphometry is crucial not only to understand the biomechanics of lumbar spine but also for abundant interventions intended at its stabilization and correction of deformities. Aims and Objective: Aims and objective was to prepare morphometric data on dimensions of lumbar vertebral body which can be used in clinical practice. An observational study was implemented where 47 dry macerated adult human lumbar vertebral sets were directly examined and their morphometric analysis in preference to vertebral body was done. Data was processed and analyzed by SPSS Ver.20. ‘ANOVA’ and ‘Z test’ were administered to evaluate statistical differences. Results: From L1 to L5, there was a gradual increase in antero-posterior (AP) diameter of superior surface. However, AP diameter of inferior surface increased up to L4 but it reduced at L5. Transverse measurements also shows gradual increase above downwards from L1 to L5. There were fluctuations in heights of vertebral bodies. There is gradual elevation of superior surface area (SA) from L1 to L5. However, inferior surface area (IA) increases up to L4 and decreases at L5. Discussion and Conclusion: The study showed highly significant differences for all vertebral dimensions except ‘posterior height’ of lumbar vertebral bodies. The generated results need to be expanded in view of larger sample size and also in known sets of male and female lumbar vertebrae in diverse population. Keywords: Dimensions, Lumbar Vertebra, Morphometry, Vertebral Body.

We present the case of a 62-year-old man who sustained a traumatic distal aortic injury associated with an adjacent lumbar vertebral body fracture resulting from a 20-ft fall. Given the site of injury, an iliac artery branched endograft was deployed off-label to preserve the aortic bifurcation and cover a limited amount of healthy aorta to preserve the collaterals. The procedure was successful, with no intraoperative complications or evidence of an endoleak. The aortic bifurcation and distal iliac arteries remained widely patent by computed tomography angiography at the follow-up examination without evidence of sequelae.

Vertebral fractures are important indicators of osteoporosis. Fractures with partial collapse of vertebral bodies are referred to as vertebral compression fractures (VCFs) that are usually non-traumatic in nature. Some common causes of VCFs are trauma, bone failure related to osteoporosis (benign) and metastatic cancer (malignant). This paper aims at developing a system for computer-aided diagnosis to help in the detection, labeling and segmentation of lumbar vertebral body (VB) and to further classify each VB into normal, malignant and benign VCFs. After the initial preprocessing, morphological, shape and angular features are used in the detection, labeling and segmentation steps. Various shape and statistical texture features are extracted from the segmented VB and are fed to the classifier for the final decision. The segmentation and classification results obtained were compared with the ground truth manual segmentation of the lumbar VB and the decision labels of the fractures provided by the experts. The dice similarity coefficient (DSC) for segmentation reached up to 94.27%, and the classification results show that shape and texture features together are able to correctly classify with an accuracy rate of 95.34%. The final outcomes are expected to be useful in the analysis of vertebral compression fractures.

We read with great interest the recently published article “Exophytic Lumbar Vertebral Body Mass in an Adult with Back Pain.” We thank John C. Benson et al[1][1] for their lucid description of imaging features of chordoma presenting as an exophytic lumbar vertebral mass. We recently encountered

All three columns of the lumbar spine are stabilized in the posterior lumbar transpedicular internal fixation technique. This technique has been widely used in the treatment of lumbar degenerative disease and lumbar fracture. Anatomic characteristics of the lumbar vertebral body, the entry point, entry angle, entry depth of the lumbar pedicle screw, and operative details are demonstrated to guarantee proper positioning of the screw. The characteristics, clinical indications and contraindications, and the surgical technique of CD HORIZON LEGACY internal fixation system are introduced in detail. The applications of these techniques are presented in typical clinical cases. Pearls and pitfalls of lumbar pedicle screw fixation are summarized at the end of this chapter.

Background/Aim: We hypothesized that regional tumor growth into L1 and L2 vertebral bodies from renal pelvis carcinoma was linked to the development of bone metastases. Materials and Methods: Criteria for the study were: (i) Metastatic renal pelvis carcinoma confirmed via pathology and computed tomographic (CT) scan, (ii) L1 and L2 invasion confirmed from retrospective CT scan review, and (iii) detection of bone metastases using radionuclide images/CT scans. Results: A total of 71 cases were enrolled in the study. Initial L1 and L2 vertebral body invasion. were detected in 45 (63%) patients. As well as L1 and L2 invasion, 32 (71%) had development of bone metastases. All bone lesions were osteolytic. Initial L1 and L2 invasion (p

Osteoporosis causes the bone mass loss and increased fracture risk. This paper presents the modelling of osteoporotic human lumbar vertebrae L1 by employing finite elements method (FEM). The isolated inhomogeneous vertebral body is composed by cortical out-er shell and cancellous bone. The level of osteoporotic contribution is characterised by reducing the thickness of cortical shell and elasticity modulus of cancellous bone using power-law dependence with apparent density. The strength parameters are evaluated on the basis of von Mises-Hencky yield criterion. Parametric study of osteoporotic degradation contains the static and nonlinear dynamic analysis of stresses that occur due to physiological load. Results of our investigation are presented in terms of nonlinear interdependence between stress and external load.

Coccidioidomycosis, also known as San Joaquin Valley Fever or Valley Fever, is mostly a pulmonary infection caused by inhalation of spores in an endemic region. Dissemination to bone, joints, meninges, and skin occurs less than one percent of the time. Skeletal involvement accounts for approximately half of the disseminated coccidioidomycosis with the vertebrae as the most common skeletal region. We present a very rare case of disseminated coccidioidomycosis with osteomyelitis and compression fracture of the lumbar vertebral body. This case depicts some of the potential issues that can arise in managing coccidioidomycosis, especially when noncompliance to initial azoles occurs, that can lead to dissemination and complicated bone infections necessitating surgical intervention along with continuous medical therapy.

Intervertebral discs are important structural components of the spine but also are significant sources of morbidity, especially for the “low back” lumbar region. Mechanical damage to, or degeneration of, the lumbar discs can diminish their structural integrity and elicit debilitating low back pain. Advancement of reparative or regenerative means to treat damaged or degenerated discs is hindered by a lack of basic understanding of the disc load-deformation characteristics in vivo. The current study presents an in vivo analysis of the morphometry and deformation of lumbar (L2-S1) intervertebral discs in 10 healthy participants while performing a common lifting act, using novel dynamic radiographic imaging of the lumbar vertebral body motion. Data analyses show uniquely different (p R2 ≥ 0.80) between strain changes and amount of lumbar flexion-extension motion compared to L5S1 (R2 ≤ 0.5). The study therefore advances the state of knowledge on in vivo mechanical responses of the lumbar intervertebral discs during functional tasks.

This study aimed to investigate the effect of estrogen withdrawal on bone tissue in adult female marmoset monkeys. In a 1-year follow-up study we used quantitative computer tomography to measure total bone mineral density (BMD) of the proximal tibia and the second-last lumbar vertebral body (L5/L6) before and 1, 3, 6, and 12 months after ovariectomy. Body mass did not significantly change during the 1-year observation period. However, a significant decline of total BMD after ovariectomy was observed in the proximal tibia but not in L5/L6. In addition, regression analysis showed a significant positive relationship between BMD and body mass in both tibia and L5/L6. The results of our study support the idea that ovariectomized marmoset monkeys may serve as a model to investigate bone loss related to decline of estrogen production.

Aim. To assess osteogenic potentialities of a three-di- components, enzymes and vessels with endothelial lining. mensional osteograft in a mini pig model with artificial Structural composition of the osteograft is an analogue of vertebral body defect. The osteograft consists of osteo- embryonic bone tissue, which was the basis for examining the regenerative potentialities of the osteograft in the ex-periment. Methods. The osteograft was implanted in the defect of the lumbar vertebral body of minipig (6 months old). The animals were withdrawn from the experiment in the period from 14 days to 6 months. In the control series, autobone was implanted in a similar defect. The preparations were examined by morphological methods, and bone tissue density was assessed by MSCT. Results. Regeneration and integration of the bone tissue of the vertebral body with the defect replaced by the osteograft was by primary angiogenic osteogene sis within one month due to the structural components of the osteograft. When the defect is replaced by autograft, the regeneration and integration of the bone tissue of the vertebral body occur within six months due to the structural components of the recipient. Conclusion. Formation of the common blood flow of the transplant and recipient vessels is both a factor of integration of the transplant into the homeostatic system of the recipient, and a pathogenic mechanism for optimizing the regeneration of bone tissue defect on the basis of the graft.

Ibandronate (IBN) and pulsed electromagnetic field (PEMF) have each shown positive effects for treating osteoporosis, but no study has evaluated the relative effects of these treatments combined. This study investigated the effects of IBN + PEMF on bone turnover, mineral density, microarchitecture, and biomechanical properties in an ovariectomized (OVX) rat model of osteoporosis. Fifty 3-month-old rats were randomly apportioned to receive a sham-operation (n = 10), or ovariectomy (n = 40). The latter group was equally divided as the model (OVX control) or to receive IBN, PEMF, or IBN + PEMF. Beginning the day after surgery, the IBN and IBN + PEMF groups received weekly subcutaneous IBN; the PEMF and IBN + PEMF groups were given daily PEMF during the same 12 weeks. After 12 weeks of treatments, biochemical parameters, bone mineral density (BMD), microarchitecture parameters, biomechanical properties, and some metabolic modulators that are involved in bone resorption were compared. The L5 lumbar vertebral body BMDs of the IBN, PEMF, and IBN + PEMF groups were 121.6%, 119.5%, and 139.6%; maximum loads were 111.4%, 112.7%, and 121.9%; and energy to failure was 130.8%, 129.2%, and 154.9% of the OVX model, respectively. The IBN + PEMF group had significantly lower levels of serum tartrate-resistant acid phosphatase 5b, and greater improvement in BMD, bone microarchitecture, and strength of the lumbar spine compared with monotherapy groups. Results showed that IBN + PEMF had a more favorable effect on the lumbar spine in this osteoporosis model than did either monotherapy. Bioelectromagnetics. © 2016 Wiley Periodicals, Inc.

BACKGROUND: Diet and exercise can promote weight loss in older adults, however there is potential to increase fracture risk due to loss of bone mineral density (BMD) known to accompany weight loss. Weight loss effects on measures of bone quality and strength are currently unknown. AIMS: The purpose of this study is to develop subject-specific finite element (FE) models of the lumbar spine and study the effect of intentional weight loss on bone strength in a pilot data set. METHODS: Computed tomography (CT) scans of the lumbar spine of 30 overweight and obese (mean BMI = 29.7±3.9 kg/m(2)), older adults (mean age = 65.9±4.6 years) undergoing an 18-month intentional weight loss intervention were obtained at baseline and post-intervention. Measures of volumetric BMD (vBMD) and variable cortical thickness were derived from each subject CT scan. Development of the subject-specific FE models of the lumbar spine involved model morphing techniques to accelerate the development of the models. vBMD-derived material properties and cortical thickness measures were directly mapped to baseline and post-intervention models. Bone strength was estimated through simulation of a quasi-static uniaxial compression test. RESULTS: From baseline to 18-month post weight loss intervention, there were statistically significant decreases in estimated bone strength (6.5% decrease; p

Introduction: The number of patients who suffered from osteoporotic vertebral fractures is increasing. Osteoporosis has been reported to affect the healing process using long bone models. However, few studies have reported using vertebrae. In this study, we created a bone defect in the anterior part of vertebral body in ovariectomized rat and evaluated the healing process. Methods: Fifty-six 12-week old Sprague Dawley rats were divided into ovariectomy (OVX) and sham operation groups. A bone defect was created in the vertebral body 8 weeks after the first surgery. In both groups, the vertebral bodies were harvested immediately or at 4, 8, or 12 weeks after the second surgery ( n = 7 at each time point). Bone volume (BV, mm3), bone volume fraction (BV/TV, %), trabecular thickness (Tb.Th, mm), trabecular number (Tb.N, 1/mm), and trabecular separation (Tb.Sp, µm) were evaluated by micro-computed tomography to assess the new bone formation. Histological analysis was also performed. Results: The BV and the BV/TV were significantly lower at 4 and 12 weeks in the OVX group compared with those in the sham group. The Tb.Th was significantly lower at 8 and 12 weeks in the OVX group. Histologically, at 12 weeks, in the OVX group, the bone had a thinner, layered structure on the surface of the defect, and the trabecular structure was less dense. Conclusion: This study demonstrated that bone mass formation was suppressed and the quality of repaired bone was poor in the healing process of vertebral body defect under osteoporotic conditions. These findings could be the key to understand the pathology of osteoporotic vertebral fracture and to develop its therapies.

To assess the relationship between the maximum volume of lumbar vertebral bodies and patient morphological features. Knowledge of the volume of the vertebral body is useful when performing vertebroplasty and kyphoplasty. 129 patients (18–85 years) were included consecutively over an 8-month period. All had been subject to abdominopelvic CT scans. The weight, height and body mass index (BMI) were known. The volume of each vertebral body was calculated using the formula V = π R 2. H (V = volume, R = radius, H = height). A statistical analysis of the data divided into three groups, men/women, men only and women only, was conducted by calculating the Pearson correlation coefficient. The volume of the vertebral body increased from L1 to L4, but the volume of the L5 vertebral body was lower than that of L3 and L4 in all three groups. The volumes of the vertebral bodies were greater in men than in women. Calculating the correlation coefficient showed that the variable most correlated with volume was patient’s height in both the men/women and women-only groups, while the most correlated variable in the male-only group was weight. Vertebral height was the variable most correlated with overall height in all three groups. There is a wide variability in the volume of lumbar vertebrae. The volume of the vertebral body appears to vary not only with a person’s height but also their weight. The vertebral body seems to expand with weight in men.

Intraosseous foreign body granuloma formation related to migrated surgical material is a rarely reported condition with variable imaging appearance. In this case report, we describe a foreign body granuloma that occurred in a lumbar vertebral body one level above a prior surgical fusion. The lytic appearance mimicked a skeletal metastasis in a 65-year-old patient with recently diagnosed renal cell carcinoma. To the best of our knowledge, this is the first reported case of a lumbar vertebral foreign body granuloma occurring distant from the site of surgery, indistinguishable from skeletal metastasis on radiologic examination.

Background The failure rate for the closed/non-surgical treatment of thoracic and lumbar vertebral body fractures (TLVBF) in trauma patients has not been adequately evaluated utilizing computed tomography (CT) studies. Methods From 2007 to 2008, consecutive trauma patients, who met inclusion criteria, with a CT diagnosis of acute TLVBF undergoing closed treatment were assessed. The failure rates for closed therapy, at 3 months post-trauma, were defined by progressive deformity, vertebral body collapse, or symptomatic/asymptomatic pseudarthrosis. The Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classification was utilized to classify the fractures (groups A1 and non-A1 fractures) and were successively followed with CT studies. Results There were 54 patients with 91 fractures included in the study; 66 were A1 fractures, and 25 were non-A1 fractures. All had rigid bracing applied with flat and upright X-ray films performed to rule out instability. None had sustained spinal cord injuries. Thirteen patients (24%) failed closed therapy [e.g. 13 failed fractures (14%) out of 91 total fractures]. Five failed radiographically only (asymptomatic), and eight failed radiographically and clinically (symptomatic). A1 fractures had a 4.5% failure rate, while non-A1 fractures failed at a rate of 40%. Conclusion Failure of closed therapy for TLVBF in the trauma population is not insignificant. Non-A1 fractures had a much higher failure rate when compared to A1 fractures. We recommend close follow-up particularly of non-A1 fractures treated in closed fashion using successive CT studies.

The purpose of this study was to determine and compare prostate size using ultrasound and computed tomography (CT). The prostate gland was evaluated in eight normal Beagle dogs. Length, depth, and width of the prostate gland were measured by ultrasound and volume of the prostate was obtained from the two ellipsoid formula (US1, US2). Height, length, width, area, and volume of the prostate gland were measured by CT. Ratios of prostatic height, length, and width to the sixth lumbar vertebral body length were calculated. There was no significant difference between the US1 and US2 method, and between US2 and CT method, respectively. The prostatic volume calculated by US1 method was significantly lower than those with CT (p = 0.029). The Upper limits of ratios of prostate length, height, and width to the length of the sixth lumbar vertebra were 1.3, 1.1, and 1.7, respectively. Among these prostate dimensions, prostate length and height could be a useful index in estimating prostate size regardless of body weight.

Study design An imaging anatomical measurement. Objective To investigate the anatomical feasibility of percutaneous kyphoplasty for lumbar osteoporotic vertebral compression fractures via a unilateral transverse process-pedicle approach (TPA). Summary of background data Kyphoplasty via a unilateral approach has been reported and good clinical results have been achieved. However, because of the lack of an anatomical study, these approaches have yet to be popularized. Methods A total of 150 lumbar vertebral bodies of 30 patients were simulated kyphoplasty on the computed tomographic scans through conventional transpedicle approach (CTA) and the TPA, respectively. Anatomical parameters including the distance between the entry point and the midline of the vertebral body, the puncture inclination angle, and the success rate of puncture were measured and compared. Results The distance between the entry point and the midline from L1 to L5 lumbar levels varied from 20.6 ± 2.2 mm to 28.6 ± 2.9 mm in the CTA group and from 23.6 ± 2.2 mm to 33.6 ± 2.9 mm in the TPA group. The entry point from L1 to L5 in the TPA group was 3.0 ± 2.1 mm to 5.1 ± 2.7 mm more lateral than that in the CTA group. The medial inclination angles from L1 to L5 were 30.2° ± 6.4° to 47.7° ± 5.4° in the TPA and 15.3° ± 6.0° to 22.8° ± 8.7° in the CTA group. The inclination angles in the TPA group were greater than that in the CTA group and the safe range of the puncture angles was also wider. The success rate was 51.7% in the CTA group and 87.7% in the TPA group. Conclusion The entry point through a TPA was localized at the midline of the transverse process, 3.0 to 5.1 mm outside the lateral margin of the pedicle projection. Compared with CTA, the puncture inclination angle in the TPA approach was much larger with a wider safe puncture range. The TPA approach allowed an easy puncture to meet or surpass the midline of the lumbar vertebral body. Level of evidence N/A.

People often have to carry a weight which increases the spinal load. Few in vivo measured spinal loading data exist for carrying a weight. The aim of this study was to measure the force increase on a vertebral body replacement (VBR) caused by carrying weights in different ways. A telemeterised VBR allowing the measurement of six load components was implanted in five patients suffering from lumbar vertebral body fractures. The patients carried different weights laterally in one or both hands, in front of the body and in a backpack. The force increase with respect to standing was more than twice as high for carrying a weight in front of the body compared with carrying it laterally. A weight of 10 kg in a backpack led to an average force increase of only 35 N. The position of the carried weight relative to the spine strongly affected the spinal load.Carrying weights increases spinal loads. The loads on a telemeterised VBR were measured in five patients carrying weights in different ways. Holding a weight in front of the body strongly increased the force, while carrying it in a backpack led to only a minor load increase.

Background: Low back pain is a very common symptom. Population based normal variations of lumbar wedging (LW) in South Indian population is not well documented in literature. This study was done to compile a database of LW valid for healthy male and female subjects in the age range of 20-60 years in South Indian population. Methods: The plain lateral radiographs of lumbar spine of 150 healthy subjects (88 males and 62 females) between 20 to 60 years were studied. The lumbar vertebral body height anteriorly (HBA) and posteriorly (HBP) were measured using CR-35X digitizer. The degree of LW was determined by the ratio of HBA /HBP. Results: There was a gradual decrease in LW cranio-caudally from L1 to L5 in both sexes being maximum at L1 (0.96 in males and 0.97 in females) and minimum at L5 (1.13 in males and 1.13 in females). LW was higher in males than in females. LW is statistically significant only at L3 level and non significant at all other levels. Positive relationship of LW to age was not found. Conclusion: The study provide the best available estimates of normal LW for the South Indian healthy subjects, which will be helpful to the clinicians, therapists and researchers as ready references to LW in South Indian population. Nepal Journal of Medical Sciences | Volume 02 | Number 01 | Jan-Jun 2013 | Page 30-33 DOI: http://dx.doi.org/10.3126/njms.v2i1.7648

Bone mass, architecture, and tissue mineral density contribute to bone strength. As body mass (BM) increases any one or combination of these properties could change to maintain structural integrity. To better understand the structural origins of vertebral fragility and gain insight into the mechanisms that govern bone adaptation, we conducted an integrative analysis of bone mass and microarchitecture in the last lumbar vertebral body from nine strepsirhine species, ranging in size from 42 g (Microcebus rufus) to 2,440 g (Eulemur macaco). Bone mass and architecture were assessed via mCT for the whole body and spherical volumes of interest (VOI). Allometric equations were estimated and compared with predictions for geometric scaling, assuming axial compression as the dominant loading regime. Bone mass, microarchitectural, and vertebral body geometric variables predominantly scaled isometrically. Among structural variables, the degree of anisotropy (Tb.DA) was the only parameter independent of BM and other trabecular architectural variables. Tb.DA was related to positional behavior. Orthograde primates had higher average Tb.DA (1.60) and more craniocaudally oriented trabeculae while lorisines had the lowest Tb.DA (1.25), as well as variably oriented trabeculae. Finally, lorisines had the highest ratio of trabecular bone volume to cortical shell volume (� 3x) and while there appears to be flexibility in this ratio, the total bone volume (trabecular þ cortical) scales isometrically (BM 1.23 ,r 2 ¼ 0.93) and appears tightly constrained. The common pattern of isometry in our measurements leaves open the question of how vertebral bodies in strepsirhine species compensate for increased BM. Anat Rec, 296:210–226, 2013. V C 2013 Wiley Periodicals, Inc.

How cortical and trabecular bone co-develop to establish a mechanically functional structure is not well understood. Comparing early postnatal differences in morphology of lumbar vertebral bodies for three inbred mouse strains identified coordinated changes within and between cortical and trabecular traits. These early coordinate changes defined the phenotypic differences among the inbred mouse strains. Age-related changes in cortical and trabecular traits have been well studied; however, very little is known about how these bone tissues co-develop from day 1 of postnatal growth to establish functional structures by adulthood. In this study, we aimed to establish how cortical and trabecular tissues within the lumbar vertebral body change during growth for three inbred mouse strains that express wide variation in adult bone structure and function. Bone traits were quantified for lumbar vertebral bodies of female A/J, C57BL/6J (B6), and C3H/HeJ (C3H) inbred mouse strains from 1 to 105 days of age (n = 6–10 mice/age/strain). Inter-strain differences in external bone size were observed as early as 1 day of age. Reciprocal and rapid changes in the trabecular bone volume fraction and alignment in the direction of axial compression were observed by 7 days of age. Importantly, the inter-strain difference in adult trabecular bone volume fraction was established by 7 days of age. Early variation in external bone size and trabecular architecture was followed by progressive increases in cortical area between 28 and 105 days of age, with the greatest increases in cortical area seen in the mouse strain with the lowest trabecular mass. Establishing the temporal changes in bone morphology for three inbred mouse strains revealed that genetic variation in adult trabecular traits were established early in postnatal development. Early variation in trabecular architecture preceded strain-specific increases in cortical area and changes in cortical thickness. This study established the sequence of how cortical and trabecular traits co-develop during growth, which is important for identifying critical early ages to further focus on intervention studies that optimize adult bone strength.

Background Recommendations exist how patients should change from one body position to another in order to keep the spinal loads low. However, until now it is not clear whether the loads are in fact lower if the patients follow these recommendations. The aim was to measure the loads while changing the body position. Methods Telemeterized vertebral body replacements have been inserted into 5 patients who had a severe compression fracture of a lumbar vertebral body. The acting loads were measured during a changing of the body position while lying and when moving from lying to sitting, from sitting to standing and vice versa. Findings When the lying patients changed their position according to the physiotherapist's recommendations, the resultant force was nearly as high as it was during relaxed standing. Otherwise, the force was nearly twice as high. Changing from a lateral lying position to sitting and vice versa caused forces of about 180% of those seen for standing when the recommendations were heeded. Without instructions, the loads were about 70% higher. Use of a trapeze bar mounted to the bed did not increase the loads. Rising from a chair with the arms hanging down laterally led to average resultant forces of 380% related to standing. Placing the hands on armrests reduced this value to 180%. Interpretation High forces may act on the spine when changing from one body position to another. These loads can be minimized when following the physiotherapist's instructions and when supporting the upper body by the arms.

This historical report focuses on the first clinical description of pseudoachondroplasia and its radiographic findings. Only half a century ago, pseudoachondroplasia was recognized as a genetic disorder with a distinct but variable phenotype of short stature, normal facial features, and progressive joint problems starting in adolescence. Radiologically, the disease is particularly intriguing because the patients appear normal at birth. The patients develop the typical gait disturbances when they begin to walk. Radiographs show the characteristic anterior tongue-shaped lumbar vertebral body changes that develop after the first year of life. This account presents the most well-known group of individuals affected by pseudoachondroplasia, the Ovitz family, who narrowly escaped death in the concentration camp of Auschwitz in 1944 because of SS physician Dr. Josef Mengele's fascination with dwarfs. It was not until 1995 that the underlying genetic defect in the COMP gene was identified on chromosome 19.

Purpose: To assess the state of cancellous tissue we analyzed the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in vertebral bone marrow. Materials and Methods: With 1.5 T magnetic resonance imaging (MRI), single-shot diffusion echo planar imaging was used with b factors of 0 and 1000 s/mm2, diffusion-sensitizing gradient in six directions, sensitivity encoding technique, effective TE of 74 msec, and TR of 1800 msec. ADC and FA were determined in the lumbar vertebral body of 11 normal subjects (age 31 632–635 years), and then compared with the bone mineral density (BMD) obtained with dual-energy x-ray absorptiometry (DXA). Moreover, fat fraction (FF) of the bone marrow was measured with spectral presaturation with inversion recovery (SPIR) in the same subject. Results: A strong negative correlation was found between ADC and BMD for low or moderate FF in vertebral bone marrow. Moreover, a significant positive correlation was noted between ADC and FF in this region. There was a positive correlation between FA and BMD, and no correlation between FA and FF in the vertebral bone marrow. Conclusion: Diffusion analyses with ADC and FA make it possible to obtain more detailed information on the structure of cancellous tissue and bone metabolism. J. Magn. Reson. Imaging 2010;31:632–635. © 2010 Wiley-Liss, Inc.

Clinical and biomechanical investigations indicate that assessment of vertebral body bone mineral density (BMD) by anteroposterior dual-energy x-ray absorptiometry (DXA) is a useful index of vertebral body strength and fracture risk in osteoporosis. However, inclusion of non-force-bearing and small-force-bearing mineralized structures, such as the posterior elements and aortic calcifications, in the measurement of anterior BMD obscures the assessment of vertebral body mass by this technique. Indeed, such interference is particularly severe in the presence of posterior element degeneration or previous spinal surgery. Recent anatomic studies illustrate that the lateral view provides unobstructed visualization of the L3, L4, and possibly L2 vertebral bodies, suggesting that supine lateral BMD may more accurately assess vertebral body fracture risk. We evaluated this hypothesis in a blinded study using human cadaver spines to compare the value of supine lateral and anteroposterior BMD in assessing vertebral body fracture force, average compressive stress, maximum stored strain energy, and strain at failure. Both measures of BMD significantly correlate with these biomechanical measures. However, statistical comparison of the methods using multiple and stepwise regression reveals that supine lateral BMD provides a better assessment of the vertebral body fracture properties than anteroposterior BMD. The enhanced predictive value of supine lateral BMD occurs because of the variable contribution of posterior element mineral to the anteroposterior BMD measurement. Evaluation to test the utility of supine lateral BMD for the assessment of fracture risk and a fracture threshold in patients with osteoporosis is therefore recommended.

Dargestellt wird der rontgenologische und klinische Verlauf einer Patientin, die im Alter von 13 Jahren nach einem Sturz eine inkomplette Berstungsfraktur des 1. Lendenwirbelkorpers und eine Impressionsfraktur des 3. LWK erlitten hatte. Durch eine dorsale Instrumentierung konnte die kurzstreckige Kyphosierung am thorakolumbalen Ubergang aufgehoben werden. Die weiteren rontgenologischen Untersuchungen zeigten eine zunehmende Korrektur der betroffenen Wirbelkorper; allerdings verblieb eine diskrete Hohenminderung. Anhand des Langzeitverlaufs uber 53 Monate wird das Korrekturpotenzial am thorakolumbalen Ubergang im Jugendalter diskutiert. We present the case of a 13-year-old female patient who sustained an incomplete burst fracture of the 1st lumbar vertebral body and an impression fracture of the 3rd vertebral body. Using a dorsal instrumentation the kyphosis of the thoracolumbar junction was treated. The radiographical follow-up indicated a correction of the involved vertebral bodies. However, complete restoration of the height of the vertebral bodies was not achieved. In view of this long-term follow-up the potential for correction of the adolescent thoracolumbar junction spine is discussed.

Skeletal scintigraphy may be performed to evaluate a suspected bone island. In general, a bone island does not demonstrate increased uptake on bone scan. A case of increased uptake in a lumbar vertebral body bone island seen on SPECT, but not conventional planar imaging, is presented.

It is well known that cervical spondylosis in athetoid cerebral palsy results from abnormal muscle tension. However there is no information on low back pain in athetoid cerebral palsy. Sixty-one athetoid cerebral palsy workers were investigated by questionnaire.Forty-one (67.2%) athetoid cerebral palsy workers had low back pain in daily life. X-ray examination was performed on 29 athetoid cerebral palsy workers. Lumbar spondylolyses were shown in 17 (58.6%). Endplate lesions of the lumbar vertebral body were found in 91 vertebras (53.5%). There were no significant differences between age and occurrence of low back pain or spondylolyses. These results suggest that abnormal athetoid mortion is related to the occurrence of the spondylolyses.

This study was designed to study the individual or combined effects of estrogen and bipedal stance "exercise" on the lumbar vertebral body (LVB) and femoral neck (FN). At 6 months of age, six rats were sacrificed as baseline controls and all the others were either bilateral sham-ovariectomized or ovariectomized (OVX). Groups of OVX rats were housed in normal height cage (NC, 28 cm) or raised height cages (RC, 33 cm) and received biweekly s.c. injections of 10 microg/kg 17 beta estradiol (E2) or vehicle for 4 and 8 weeks. Histomorphometric measurements were performed on the undecalcified mid-transverse sections of the 4th LVB and FN. Ovariectomy alone induced cancellous bone loss by 21% and 39% in the LVB and FN, respectively; intracortical porosity area of the FN increased by 108% while total bone area did not change significantly because of the periosteal expansion following OVX. E2 alone partially prevented cancellous bone loss in the LVB and FN and prevented increased intracortical porosity area in the FN by reducing eroded surface and activation frequency. RC alone partially prevented the decrease of cancellous bone in the LVB and FN by reducing the bone-eroded surface but increased wall width. E2 plus RC completely preserved cancellous bone by having an additive effect on reducing eroded surface and activation frequency. RC helped to partially prevent decreased periosteal bone formation after estrogen administration. In conclusion, apart from inducing cancellous bone loss in the LVB and FN, OVX also increased intracortical remodeling in the FN. Estrogen prevented the overall activation of remodeling space induced by OVX. Apart from having similar effects as estrogen on remodeling space, RC induced positive bone balance within each remodeling unit. Combination treatment increased total bone mass beyond that of sham-control level by having an additive effect on lowering bone remodeling and increasing wall in both the LVB and FN.

Age-related changes of vertebra and iliac crest 3D microstructure were investigated, and we showed that they were in general similar. The 95th percentile of vertebral trabecular thickness distribution increased with age for women. Surprisingly, vertebral and iliac crest bone microstructure was only weakly correlated (r = 0.38 to 0.75), despite the overall similar age-related changes.INTRODUCTION: The purposes of the study were to determine the age-related changes in iliac and vertebral bone microstructure for women and men over a large age range and to investigate the relationship between the bone microstructure at these skeletal sites.METHODS: Matched sets of transiliac crest bone biopsies and lumbar vertebral body (L2) specimens from 41 women (19-96 years) and 39 men (23-95 years) were micro-computed tomography (μCT) scanned, and the 3D microstructure was quantified.RESULTS: For both women and men, bone volume per total volume (BV/TV), connectivity density (CD), and trabecular number (Tb.N) decreased significantly, while structure model index (SMI) and trabecular separation (Tb.Sp) increased significantly with age at either skeletal site. Vertebral trabecular thickness (Tb.Th) was independent of age for both women and men, while iliac Tb.Th decreased significantly with age for men, but not for women. In general, the vertebral and iliac age-related changes were similar. The 95th percentile of the Tb.Th distribution increased significantly with age for women but was independent of age for men at the vertebral body, while it was independent of age for either sex at the iliac crest. The Tb.Th probability density functions at the two skeletal sites became significantly more similar with age for women, but not for men. The microstructural parameters at the iliac crest and the vertebral bodies were only moderately correlated from r = 0.38 for SMI in women to r = 0.75 for Tb.Sp in men.CONCLUSION: Age-related changes in vertebral and iliac bone microstructure were in general similar. The iliac and vertebral Tb.Th distributions became more similar with age for women. Despite the overall similar age-related changes in trabecular bone microstructure, the vertebral and iliac bone microstructural measures were only weakly correlated (r = 0.38 to 0.75). Summary Age-related changes of vertebra and iliac crest 3D microstructure were investigated, and we showed that they were in general similar. The 95th percentile of vertebral trabecular thickness distribution increased with age for women. Surprisingly, vertebral and iliac crest bone microstructure was only weakly correlated (r = 0.38 to 0.75), despite the overall similar age-related changes.Introduction The purposes of the study were to determine the age-related changes in iliac and vertebral bone microstructure for women and men over a large age range and to investigate the relationship between the bone microstructure at these skeletal sites.Methods Matched sets of transiliac crest bone biopsies and lumbar vertebral body (L2) specimens from 41 women (19–96 years) and 39 men (23–95 years) were micro-computed tomography (μCT) scanned, and the 3D microstructure was quantified.Results For both women and men, bone volume per total volume (BV/TV), connectivity density (CD), and trabecular number (Tb.N) decreased significantly, while structure model index (SMI) and trabecular separation (Tb.Sp) increased significantly with age at either skeletal site. Vertebral trabecular thickness (Tb.Th) was independent of age for both women and men, while iliac Tb.Th decreased significantly with age for men, but not for women. In general, the vertebral and iliac age-related changes were similar. The 95th percentile of the Tb.Th distribution increased significantly with age for women but was independent of age for men at the vertebral body, while it was independent of age for either sex at the iliac crest. The Tb.Th probability density functions at the two skeletal sites became significantly more similar with age for women, but not for men. The microstructural parameters at the iliac crest and the vertebral bodies were only moderately correlated from r = 0.38 for SMI in women to r = 0.75 for Tb.Sp in men.Conclusion Age-related changes in vertebral and iliac bone microstructure were in general similar. The iliac and vertebral Tb.Th distributions became more similar with age for women. Despite the overall similar age-related changes in trabecular bone microstructure, the vertebral and iliac bone microstructural measures were only weakly correlated (r = 0.38 to 0.75).

(Purpose) It is well known that lumbar bone mineral density is high in spondylosis deformans. We examined the relationship between change in spondylosis and general bone mineral density. (Subjects and Methods) The subjects of our investigation consisted of 90 women (average 46.4 years) around post menopouse. We examined A-P X-ray of their lumbar spine and measured bone mineral density of the lumbar spine, radius, and calcaneous. The deformed degree of the lumbar spine indicated bone spur (from L1 to L5 vertebral body), and we compared these three parts using the total estimated value of five stages (0-4) with Nathan classifications. For bone mineral density, we examined relationship with the degree of lumbar spinal deformity by using Z-score. (Results) We divided the patients into two groups: H group and L group. The H group scored above 4 points with the Nathan classification, and the L group below 4 points. The bone mineral density of all three parts was highly significant (P

We report a young man with low back pain suspected to have a disc protrusion. Imaging suggested a tumour of the dorsal portion of the fifth lumbar vertebral body. Operation suggested a giant-cell tumour and subsequent histology showed an osteoblastoma. All typical imaging features of osteoblastoma are demonstrated in this rather uncommon location. Contrast-enhancing bone-marrow oedema on MRI, with mild enhancement of the tumour, together with the CT appearances were the clues to the diagnosis.

Objectives Resection of metastases of lumbar vertebrae and replacement with an expandable implant of modular design.

We describe two patients with an atypical congenital kyphosis in which a hypoplastic lumbar vertebral body lay in the spinal canal because of short pedicles. There were no defects in the posterior elements, or any apparent instability of the facet joints. Both patients were treated successfully by anterior fusion to the levels immediately above and below the affected vertebra, and posterior fusion which extended one level more both proximally and distally. This gave progressive correction of the kyphotic deformity by allowing some continued anterior growth at the levels which had been fused posteriorly.

The technique of lumbar vertebral body screw insertion is described in detail. The exposure, starting point determination, and direction of insertion are all discussed. The specifics of the use of the joystick or gear shift followed by the nuances of the insertion of the screw itself are detailed.

STUDY DESIGN A finite element parametric analysis to investigate the relative load carrying roles of the shell and centrum in the lumbar vertebral body. OBJECTIVE To address the issue of the structural role of the vertebral shell and clarify some of the contradictions raised by previous studies. SUMMARY OF BACKGROUND DATA A number of experimental and finite element studies have attempted to quantify the relative structural roles of the shell and centrum, but these studies support no consensus on the relative contribution of the shell to vertebral body strength. METHODS The authors developed finite element models to predict the fraction of the total compressive force acting on the lumbar vertebral body that is carried by the shell. Parametric variations were investigated to determine how the fraction of shell force was affected by changes in shell thickness, shell and centrum modulus, centrum anistropy, and loading conditions. RESULTS The fraction of compressive force carried by the shell increased from approximately 0 at the endplate to approximately 0.2 at the mid-transverse plane for a typical case. The shell force was highly sensitive to the degree of anisotropy of the trabecular centrum but was relatively insensitive to changes in shell thickness and the ratio of shell-to-centrum elastic modulus. CONCLUSIONS The conflicting conclusions of previous studies about the structural roles of the vertebral shell and centrum can be explained by differences in their methods. Our findings support the claims that the shell accounts for only approximately 10% of vertebral strength in vivo and that the trabecular centrum is the dominant structural component of the vertebral body.

A 74-year-old patient was admitted to our hospital with recurrent ameloblastoma of the right mandible. Multiple lung nodules were noted during the presurgical evaluation. FDG PET/CT was subsequently performed to assess the nature of the nodules and search the possible primary tumors. The images showed abnormal FDG activity not only in the lung nodules but also in the lumbar vertebral body and the liver. Pathologic examination after hepatic biopsy demonstrated metastases from ameloblastoma.

BACKGROUND AND PURPOSE: The prevalence of facet joint signal change in acute/subacute lumbar vertebral body compression fractures is unknown. We hypothesized that facet joint signal change on MR imaging is more common in facet joints associated with an acute/subacute lumbar compression fracture than those associated with normal vertebral bodies or ones that have a chronic compression fracture. MATERIALS AND METHODS: Three neuroradiologists and a neuroradiology fellow retrospectively graded facet joint inflammatory change on MR imaging in 900 facet joints in 75 patients with at least 1 painful osteoporotic lumbar compression fracture. Facet joint signal change was assessed on T2-weighted images with chemical fat-saturation, STIR images, and/or gadolinium-enhanced T1-weighted images with chemical fat-saturation. Each facet joint from the T12/L1 to L5/S1 level was assessed individually. An overall facet joint signal-change score, which is a composite measure of the grade of signal change for all 4 facet joints associated with a given lumbar vertebral level, was devised, and statistical significance was assessed via Wilcoxon rank sum tests. RESULTS: The overall facet joint signal-change scores were significantly higher at vertebral body levels affected by an acute/subacute compression fracture compared with control levels, which were associated with either normal bodies or chronic compression fractures. CONCLUSIONS: Our findings suggest an association between facet joint signal change on MR imaging and acute/subacute lumbar vertebral body compression fractures.