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Cervical endplate bone density distribution measured by CT osteoabsorptiometry and direct comparison with mechanical properties of the endplate

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Abstract

Purpose

Intervertebral device subsidence is one of the complications of anterior cervical discectomy and fusion. The biomechanical properties of vertebral bony endplate may be related to device subsidence. The aim of this study is to measure the cervical endplate bone density distribution using a novel 3D measurement method.

Methods

Eight human cadaver cervical spines were obtained and levels C3-C7 were dissected and CT scanned. Three-dimensional (3D) CT model was created with the same 3D coordinates of the original DICOM dataset. The regional strength and stiffness of the endplate were determined by indentation testing. The indentation points were recorded by a photograph and the location of the indentation points was projected to the 3D CT model. Three-dimensional coordinates of the indentation point was obtained in the 3D space determined by the DICOM dataset. The area underneath the indentation point was calculated by a trilinear interpolation method directly. Data in HU and correlations with the indentation strength and stiffness were analysed.

Results

A positive correlation was found between HU and strength (r = 0.52) and between HU and stiffness (r = 0.41). Overall, mechanical strength and stiffness and HU in the superior endplate of the caudal vertebra were lower than those in the inferior endplate of the cranial vertebra in the same intervertebral disc.

Conclusions

The mechanical properties and the HU were found to be significantly correlated, which employed a novel 3D HU measurement method, thus demonstrating potential to predict cervical endplate failure risk in a clinical setting.

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Availability of data and material

The datasets during and/or analysed during the current study available from the corresponding author on reasonable request.

Abbreviations

ACDF:

Anterior cervical discectomy and fusion

IVD:

Intervertebral disc

DEXA:

Dual energy x-ray absorptiometry

3D:

Three dimensional

HU:

Hounsfield Units

ROI:

Range of interest

BMD:

Bone mineral density

References

  1. Watanabe S, Inoue N, Yamaguchi T, Hirano Y, Espinoza Orias AA, Nishida S, Hirose Y, Mizuno J (2012) Three-dimensional kinematic analysis of the cervical spine after anterior cervical decompression and fusion at an adjacent level: a preliminary report. Eur Spine J 21:946–955. https://doi.org/10.1007/s00586-011-2090-1

    Article  PubMed  Google Scholar 

  2. Park JY, Choi KY, Moon BJ, Hur H, Jang JW, Lee JK (2016) Subsidence after single-level anterior cervical fusion with a stand-alone cage. J Clin Neurosci 33:83–88. https://doi.org/10.1016/j.jocn.2016.01.042

    Article  PubMed  Google Scholar 

  3. Tome-Bermejo F, Morales-Valencia JA, Moreno-Perez J, Marfil-Perez J, Diaz-Dominguez E, Pinera AR, Alvarez L (2017) Degenerative cervical disc disease: long-term changes in sagittal alignment and their clinical implications after cervical interbody fusion cage subsidence: a prospective study with standalone lordotic tantalum cages. Clin Spine Surg 30:E648-e655. https://doi.org/10.1097/bsd.0000000000000293

    Article  PubMed  Google Scholar 

  4. Igarashi H, Hoshino M, Omori K, Matsuzaki H, Nemoto Y, Tsuruta T, Yamasaki K (2019) Factors influencing interbody cage subsidence following anterior cervical discectomy and fusion. Clin Spine Surg 32:297–302. https://doi.org/10.1097/BSD.0000000000000843

    Article  PubMed  Google Scholar 

  5. Veeravagu A, Cole T, Jiang B, Ratliff JK (2014) Revision rates and complication incidence in single- and multilevel anterior cervical discectomy and fusion procedures: an administrative database study. Spine J 14:1125–1131. https://doi.org/10.1016/j.spinee.2013.07.474

    Article  PubMed  Google Scholar 

  6. Mende KC, Eicker SO, Weber F (2018) Cage deviation in the subaxial cervical spine in relation to implant position in the sagittal plane. Neurosurg Rev 41:267–274. https://doi.org/10.1007/s10143-017-0850-z

    Article  PubMed  Google Scholar 

  7. Ordway NR, Lu YM, Zhang X, Cheng CC, Fang H, Fayyazi AH (2007) Correlation of cervical endplate strength with CT measured subchondral bone density. Eur Spine J 16:2104–2109. https://doi.org/10.1007/s00586-007-0482-z

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nguyen C, Poiraudeau S, Rannou F (2012) Vertebral subchondral bone. Osteoporos Int 23(Suppl 8):S857-860. https://doi.org/10.1007/s00198-012-2164-x

    Article  PubMed  Google Scholar 

  9. Ordway NR, Lu YM, Zhang X, Cheng CC, Fang H, Fayyazi AH (2007) Structural property distribution of the cervical endplate and the correlation with CT measured subchondral bone density. Eur Spine J 16:2110. https://doi.org/10.1007/s00586-007-0505-9

    Article  PubMed  PubMed Central  Google Scholar 

  10. Muller-Gerbl M, Weisser S, Linsenmeier U (2008) The distribution of mineral density in the cervical vertebral endplates. Eur Spine J 17:432–438. https://doi.org/10.1007/s00586-008-0601-5

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lim TH, Kwon H, Jeon CH, Kim JG, Sokolowski M, Natarajan R, An HS, Andersson GB (2001) Effect of endplate conditions and bone mineral density on the compressive strength of the graft-endplate interface in anterior cervical spine fusion. Spine(Phila Pa 1976) 26:951–956. https://doi.org/10.1097/00007632-200104150-00021

    Article  CAS  Google Scholar 

  12. Bailey CS, Sjovold SG, Dvorak MF, Fisher CG, Oxland TR (2011) The strength profile of the thoracolumbar endplate reflects the sagittal contours of the spine. Spine(Phila Pa 1976) 36:124–128. https://doi.org/10.1097/BRS.0b013e3181cc8a32

    Article  Google Scholar 

  13. Kishimoto M, Akeda K, Sudo A, Espinoza Orias AA, Inoue N (2016) In vivo measurement of vertebral endplate surface area along the whole-spine. J Orthop Res 34:1418–1430. https://doi.org/10.1002/jor.23354

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chahla J, Liu JN, Manderle B, Beletsky A, Cabarcas B, Gowd A, Inoue N, Chubinskaya S, Trenhaile S, Forsythe B, Cole B, Verma N (2019) Bony ingrowth of coil-type open architecture anchors compared with screw-type PEEK anchors for the medial row in rotator cuff repair. Arthroscopy, A Randomized Controlled Trial. https://doi.org/10.1016/j.arthro.2019.11.119

    Book  Google Scholar 

  15. Cheng CC, Ordway NR, Zhang X, Lu YM, Fang H, Fayyazi AH (2007) Loss of cervical endplate integrity following minimal surface preparation. Spine(Phila Pa 1976) 32:1852–1855. https://doi.org/10.1097/BRS.0b013e31811ece5a

    Article  Google Scholar 

  16. Brenke C, Dostal M, Scharf J, Weiss C, Schmieder K, Barth M (2015) Influence of cervical bone mineral density on cage subsidence in patients following stand-alone anterior cervical discectomy and fusion. Eur Spine J 24:2832–2840. https://doi.org/10.1007/s00586-014-3725-9

    Article  PubMed  Google Scholar 

  17. Panjabi MM, Chen NC, Shin EK, Wang JL (2001) The cortical shell architecture of human cervical vertebral bodies. Spine(Phila Pa 1976) 26:2478–2484. https://doi.org/10.1097/00007632-200111150-00016

    Article  CAS  Google Scholar 

  18. Lim S, Joung H, Shin CS, Lee HK, Kim KS, Shin EK, Kim HY, Lim MK, Cho SI (2004) Body composition changes with age have gender-specific impacts on bone mineral density. Bone 35:792–798. https://doi.org/10.1016/j.bone.2004.05.016

    Article  PubMed  Google Scholar 

  19. Feng H, Li H, Ba Z, Chen Z, Li X, Wu D (2019) Morphometry evaluations of cervical osseous endplates based on three dimensional reconstructions. Int Orthop 43:1521–1528. https://doi.org/10.1007/s00264-018-4053-1

    Article  PubMed  Google Scholar 

  20. Muller-Gerbl M, Putz R, Hodapp N, Schulte E, Wimmer B (1989) Computed tomography-osteoabsorptiometry for assessing the density distribution of subchondral bone as a measure of long-term mechanical adaptation in individual joints. Skeletal Radiol 18:507–512. https://doi.org/10.1007/bf00351749

    Article  CAS  PubMed  Google Scholar 

  21. Muller-Gerbl M, Putz R, Kenn R (1992) Demonstration of subchondral bone density patterns by three-dimensional CT osteoabsorptiometry as a noninvasive method for in vivo assessment of individual long-term stresses in joints. J Bone Miner Res 7(Suppl 2):S411-418. https://doi.org/10.1002/jbmr.5650071409

    Article  PubMed  Google Scholar 

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Acknowledgements

I would like to thank for Dr Hidetoshi Nojiri and Sayuri Kitahata for advice on experiments.

Funding

This study was supported by research funding from Orthopedic Biomechanics Fund at Rush University Medical Center for costs of cadaveric specimens. The funding source had no role in the study design, data collection or interpretation of results. There was no additional external funding received for this study.

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Authors and Affiliations

  1. Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan

    Takeshi Hara, Yukoh Ohara, Eiji Abe & Hajime Arai

  2. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA

    Kaosu Takami, Alejandro A. Espinoza Orías & Nozomu Inoue

Authors
  1. Takeshi Hara
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  2. Yukoh Ohara
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  3. Eiji Abe
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  4. Kaosu Takami
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  5. Alejandro A. Espinoza Orías
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  6. Hajime Arai
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  7. Nozomu Inoue
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Contributions

Alejandro A. EspinozaOrı ́as involved in data curation. Alejandro A. EspinozaOrı ́as participated in formal analysis. Takeshi Hara, Yukoh Ohara, Kaosu Takami, Eiji Abe involved in investigation. Nozomu Inoue involved in methodology. Nozomu Inoue participated in project administration. Nozomu Inoue participated in software. Nozomu Inoue and Hajime Arai supervised the study. Takeshi Hara involved in writing—original draft. Nozomu Inoue involved in writing—review&editing.

Corresponding author

Correspondence to Takeshi Hara.

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No potential conflicts of interest are disclosed.

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This study was approved by the Rush University ethical committee.

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Hara, T., Ohara, Y., Abe, E. et al. Cervical endplate bone density distribution measured by CT osteoabsorptiometry and direct comparison with mechanical properties of the endplate. Eur Spine J 30, 2557–2564 (2021). https://doi.org/10.1007/s00586-021-06920-2

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  • DOI: https://doi.org/10.1007/s00586-021-06920-2

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