BACKGROUND Spinal osteoporosis is a prevalent health condition characterized by the thinning of bone tissues in the spine,increasing the risk of fractures.Given its high incidence,especially among older populations,it...BACKGROUND Spinal osteoporosis is a prevalent health condition characterized by the thinning of bone tissues in the spine,increasing the risk of fractures.Given its high incidence,especially among older populations,it is critical to have accurate and effective predictive models for fracture risk.Traditionally,clinicians have relied on a combination of factors such as demographics,clinical attributes,and radiological characteristics to predict fracture risk in these patients.However,these models often lack precision and fail to include all potential risk factors.There is a need for a more comprehensive,statistically robust prediction model that can better identify high-risk individuals for early intervention.AIM To construct and validate a model for forecasting fracture risk in patients with spinal osteoporosis.METHODS The medical records of 80 patients with spinal osteoporosis who were diagnosed and treated between 2019 and 2022 were retrospectively examined.The patients were selected according to strict criteria and categorized into two groups:Those with fractures(n=40)and those without fractures(n=40).Demographics,clinical attributes,biochemical indicators,bone mineral density(BMD),and radiological characteristics were collected and compared.A logistic regression analysis was employed to create an osteoporotic fracture risk-prediction model.The area under the receiver operating characteristic curve(AUROC)was used to evaluate the model’s performance.RESULTS Factors significantly associated with fracture risk included age,sex,body mass index(BMI),smoking history,BMD,vertebral trabecular alterations,and prior vertebral fractures.The final risk-prediction model was developed using the formula:(logit[P]=-3.75+0.04×age-1.15×sex+0.02×BMI+0.83×smoking history+2.25×BMD-1.12×vertebral trabecular alterations+1.83×previous vertebral fractures).The AUROC of the model was 0.93(95%CI:0.88-0.96,P<0.001),indicating strong discriminatory capabilities.CONCLUSION The fracture risk-prediction model,utilizing accessible clinical,biochemical,and radiological information,offered a precise tool for the evaluation of fracture risk in patients with spinal osteoporosis.The model has potential in the identification of high-risk individuals for early intervention and the guidance of appropriate preventive actions to reduce the impact of osteoporosis-related fractures.展开更多
Background Older patients with malignant spinal tumors are difficult to treat because they have many co-morbidities including osteoporosis. The purpose of this research is to discuss the technique and clinical outcome...Background Older patients with malignant spinal tumors are difficult to treat because they have many co-morbidities including osteoporosis. The purpose of this research is to discuss the technique and clinical outcome of bone cement enhanced pedicle screw fixation combined with vertebroplasty （the Sandwich Procedure） for elderly patients with severe osteoporosis and malignant spinal tumors. Methods This study includes 28 consecutive elderly patients with malignant thoracic or lumbar spinal tumors. There were nine patients with myelomas, and 19 patients with metastatic bone tumors. The Sandwich Procedure began with curettage of the tumor and a vertebroplasty with bone cement （polymethyl methacrylate, PMMA）, followed by PMMA enhanced pedicle screw fixation. Patients were evaluated with the visual analogue scale （VAS）, oswestry disability index （ODI）, American Spinal Cord Injury Association （ASIA） neurological function classification, and the radiographic degree of kyphosis （Cobb angle）. Data were analyzed using paired t-test to compare the pre- and post-operative values. The complications, local recurrences, and the survival status were also recorded. Results There was no operative mortality, and the mean operative time was 210 minutes （range 150-250 minutes）. The average blood loss was 1550 ml （range 650-3300 ml）. The average amount of cement for vertebroplasty was 3.6 ml （range 3-5 ml）. The VAS, ODI, and ASIA scores were significantly improved after surgery （P 〈0.05）. However, we found no differences between the pre and post-operative Cobb angles. The shortest survival time was 3 months, and we found no evidence of local recurrence in this group of patients. Conclusion The Sandwich Procedure is a safe operation and provides symptomatic relief in these difficult patients, permitting further treatment with chemotherapy or radiotherapy.展开更多
文摘BACKGROUND Spinal osteoporosis is a prevalent health condition characterized by the thinning of bone tissues in the spine,increasing the risk of fractures.Given its high incidence,especially among older populations,it is critical to have accurate and effective predictive models for fracture risk.Traditionally,clinicians have relied on a combination of factors such as demographics,clinical attributes,and radiological characteristics to predict fracture risk in these patients.However,these models often lack precision and fail to include all potential risk factors.There is a need for a more comprehensive,statistically robust prediction model that can better identify high-risk individuals for early intervention.AIM To construct and validate a model for forecasting fracture risk in patients with spinal osteoporosis.METHODS The medical records of 80 patients with spinal osteoporosis who were diagnosed and treated between 2019 and 2022 were retrospectively examined.The patients were selected according to strict criteria and categorized into two groups:Those with fractures(n=40)and those without fractures(n=40).Demographics,clinical attributes,biochemical indicators,bone mineral density(BMD),and radiological characteristics were collected and compared.A logistic regression analysis was employed to create an osteoporotic fracture risk-prediction model.The area under the receiver operating characteristic curve(AUROC)was used to evaluate the model’s performance.RESULTS Factors significantly associated with fracture risk included age,sex,body mass index(BMI),smoking history,BMD,vertebral trabecular alterations,and prior vertebral fractures.The final risk-prediction model was developed using the formula:(logit[P]=-3.75+0.04×age-1.15×sex+0.02×BMI+0.83×smoking history+2.25×BMD-1.12×vertebral trabecular alterations+1.83×previous vertebral fractures).The AUROC of the model was 0.93(95%CI:0.88-0.96,P<0.001),indicating strong discriminatory capabilities.CONCLUSION The fracture risk-prediction model,utilizing accessible clinical,biochemical,and radiological information,offered a precise tool for the evaluation of fracture risk in patients with spinal osteoporosis.The model has potential in the identification of high-risk individuals for early intervention and the guidance of appropriate preventive actions to reduce the impact of osteoporosis-related fractures.
文摘Background Older patients with malignant spinal tumors are difficult to treat because they have many co-morbidities including osteoporosis. The purpose of this research is to discuss the technique and clinical outcome of bone cement enhanced pedicle screw fixation combined with vertebroplasty （the Sandwich Procedure） for elderly patients with severe osteoporosis and malignant spinal tumors. Methods This study includes 28 consecutive elderly patients with malignant thoracic or lumbar spinal tumors. There were nine patients with myelomas, and 19 patients with metastatic bone tumors. The Sandwich Procedure began with curettage of the tumor and a vertebroplasty with bone cement （polymethyl methacrylate, PMMA）, followed by PMMA enhanced pedicle screw fixation. Patients were evaluated with the visual analogue scale （VAS）, oswestry disability index （ODI）, American Spinal Cord Injury Association （ASIA） neurological function classification, and the radiographic degree of kyphosis （Cobb angle）. Data were analyzed using paired t-test to compare the pre- and post-operative values. The complications, local recurrences, and the survival status were also recorded. Results There was no operative mortality, and the mean operative time was 210 minutes （range 150-250 minutes）. The average blood loss was 1550 ml （range 650-3300 ml）. The average amount of cement for vertebroplasty was 3.6 ml （range 3-5 ml）. The VAS, ODI, and ASIA scores were significantly improved after surgery （P 〈0.05）. However, we found no differences between the pre and post-operative Cobb angles. The shortest survival time was 3 months, and we found no evidence of local recurrence in this group of patients. Conclusion The Sandwich Procedure is a safe operation and provides symptomatic relief in these difficult patients, permitting further treatment with chemotherapy or radiotherapy.
