Michael J. Durst's scientific contributions

Purpose Vertebral compression fractures (VCFs) are common and associated with high morbidity including severe, debilitating pain. Percutaneous vertebroplasty/kyphoplasty is a demonstrated effective treatment for VCF. Sarcopenia has been implicated as a risk factor for VCF and refracture following cement augmentation, and as a risk factor for procedural complications in some populations; however, the effect of sarcopenia on VCF patients undergoing these procedures is unknown. This study aims to improve outcomes and patient selection by investigating the effects of highly common VCF comorbidities. Methods A retrospective study was performed of all patients who underwent vertebroplasty/kyphoplasty for treatment of VCF at a single center from 2007 to 2020. Sarcopenia was quantified by normalized total psoas area (TPA) as measured on computed tomography. The effect of sarcopenia, bone density t -score, and clinical and demographic covariates on periprocedural pain scores was evaluated with linear mixed-effects models. Results Out of 458 procedures performed, 146 and 130 were included in the sarcopenia and osteoporosis analyses, respectively. Sarcopenia and osteoporosis were highly comorbid in VCF patients undergoing vertebroplasty/kyphoplasty. Linear mixed-effects modeling showed no significant association between change in pain score and TPA score ( p = 0.827) or bone density t -score ( p = 0.818). Conclusion Postprocedural pain reduction after vertebroplasty/kyphoplasty is not associated with the presence or severity of sarcopenia or osteoporosis/osteopenia. Appropriate patient selection remains critical to optimize the risk–benefit ratio of vertebroplasty/kyphoplasty, and sarcopenia and osteoporosis should not be considered contraindications to these procedures.

Purpose: Distinguishing between acute and chronic vertebral compression fractures typically requires advanced imaging techniques such as magnetic resonance imaging (MRI). Recognizing specific radiographic findings associated with fracture acuity may improve the accuracy of radiographic assessment. Methods: Patients with compression fractures that had both radiographic and MRI studies of the lumbar spine within a 30-day time frame were retrospectively reviewed. MRI studies were used to determine compression fracture acuity. Radiographs were interpreted by a separate group of radiologists blinded to the MRI results. Radiographic findings of endplate osteophyte, subendplate density, subendplate cleft, and subendplate cyst were recorded as was the overall impression of fracture acuity. Results: Sensitivity and specificity for radiographic reporting of acute fracture were 0.52 (95% CI: 0.42, 0.61) and 0.95 (95% CI: 0.93, 0.97) respectively. For chronic fractures, the sensitivity and specificity were 0.52 (95% CI: 0.41, 0.63) and 0.94 (95% CI: 0.92, 0.96). The radiographic presence of a subendplate cleft increased the odds of a fracture being acute by a factor of 1.75 (95% CI: 1.09, 2.81; P = 0.0202). The radiographic presence of subendplate density increased the odds of a fracture being acute by a factor of 1.78 (95% CI: 1.21, 2.63; P = 0.0037). The presence of an endplate osteophyte or subendplate cyst was not significantly associated with fracture acuity. Conclusion: Radiographs are relatively insensitive in distinguishing between acute and chronic lumbar compression fractures but the presence of a subendplate cleft or subendplate density increases the likelihood that a given fracture is acute.

Background Fatty masses are common and may be encountered in the foot and ankle. In some cases, normal subcutaneous fat may be mistaken for a discrete mass. Aims The aim of this study was to evaluate the common finding of prominent subcutaneous fat at the medial midfoot resembling a lipoma and to determine the prevalence of this pseudolesion by applying a series of potential size cutoff criteria. Materials and Methods Three musculoskeletal radiologists retrospectively evaluated 91 sequentially performed magnetic resonance imaging examinations of the ankle to measure fat resembling a discrete lipoma at the medial midfoot. Each blinded reader measured the largest area of continuous subcutaneous fat in orthogonal axial, coronal craniocaudal, and coronal transverse dimensions. Patient age, sex, and study indications were also recorded. Statistical analysis was performed with R and SAS 9.4 software Results A discrete fatty pseudolesion as defined by measuring at least 1 cm in all planes by measurements of at least two of three readers was present in 87% of cases (79 of 91). When a size criterion of 1.5 cm was used, a pseudolesion was documented in 14% of cases (13 of 91). There was a significant correlation between larger pseudolesion size and female sex in the axial plane; however, there was no correlation in the coronal craniocaudal and coronal transverse dimensions. Conclusions Subcutaneous fat at the medial midfoot often has a mass-like appearance that could be mistaken for a lipoma. It is important to recognize this pseudolesion variant and not to confuse the imaging appearance for a discrete mass.

PURPOSE: This study assesses the effect of a practicum utilizing low-cost, anatomically accurate 3D-printed models on trainees' bone biopsy skills using a powered device as well as self-assessed preparedness. METHODS AND MATERIALS: This study was IRB-exempted. Following a presentation highlighting manufacturer's provided instructions, trainees performed a biopsy on 3D printed models and were graded by a predetermined rubric. Following the initial attempt, a hands-on tutorial was provided with a subsequent graded biopsy attempt. Prior to and following the tutorial, trainees rated the utility of the tutorial, bone model usefulness, and personal anxiety/technical preparedness in performing bone biopsies on a 10-point Likert scale. Self-reported scores and grading of each trainee were compared using Wilcoxon signed-rank test with significance level at 0.05. RESULTS: 24 trainees completed pre-and post-tutorial surveys, with 83.3% rating the 3D model tutorial 9-10 (extremely useful) and 16.7% rating it 7 to 8 (Mean 9.42, SD 0.88). Assessing the manufacturer's instructions, 95.5% subjects rated it 1 (not useful) to 5 (neutral) and 4.5% rated it 8 (Mean 2.23, SD 1.875). Self confidence increased from an average of 2.096 (SD 1.73) to 7.29 (SD 1.71), p < 0.001. Self-described anxiety decreased from an average of 7.08 (SD 2.45) to 4.58 (SD 2.4), p < 0.001. Biopsy technique was graded for 21 trainees and a Wilcoxon signed-rank test demonstrated improved initial access, p = 0.001, biopsy access p < 0.001, sample p = 0.035, drill technique p < 0.001, and removal, p = 0.001. CONCLUSION: 3D-printed bone biopsy models can serve as affordable, readily-available, and effective training tools to improve technical skills and confidence in performing biopsies.