Diaphragm thickness and stiffness in patients with hyperkyphosis due to osteoporotic vertebral fracture: an ultrasonographic and elastographic study

Abstract

Purpose The objective of this study was to evaluate the thickness and stiffness of the diaphragm, using ultrasound (US) and strain elastography (SE) in patients with hyperkyphosis due to osteoporotic vertebral fracture. Material and methods This prospective and case-control study was conducted between October 2019 and December 2019. Diaphragm thickness, SE, and strain ratio values of patients with hyperkyphosis due to osteoporotic vertebral fracture were compared with those of the control group. Results There were 42 patients (14 males, 28 females) with a mean age of 81.10 ± 6.3 years in the kyphosis group and 36 subjects (11 males, 25 females) with a mean age of 81.00 ± 5.5 years in the control group. End-inspirium thickness, change level, and thickening ratio of the diaphragm were significantly higher in the control group ( p < 0.001 for all). Strain ratio values were significantly higher in the kyphosis group, and the rate of hardest colour code was significantly higher in the control group. The diaphragm thickness at end-inspirium and thickening ratio values correlated positively with the forced expiratory volume in the first second (FEV 1 , %) and forced vital capacity (FVC, %) values. The strain ratio values correlated inversely with the FEV 1 (%) and FVC (%) values. The diaphragm thickness at end-inspirium and thickening ratio values correlated inversely with the Cobb values and number of vertebra fractures. A positive correlation was determined between the strain ratio values and the Cobb values and number of vertebra fractures. Conclusions Ultrasonography is a promising imaging tool to evaluate and quantify the diaphragm function and stiffness in relevant patients.

Diaphragmatic ultrasound can help evaluate pulmonary dysfunction in patients with stroke

“…The diaphragm is the main respiratory muscle as its movement provides approximately two-thirds of the pulmonary capacity. Correlations between pulmonary function and diaphragmatic ultrasound indices have been reported in some studies, including between FEV1, FVC, and TF in patients with osteoporosis, vertebral fracture, and kyphosis ( 5 ); between MIP, FVC, TF, and DT in patients with late-onset Pompe disease ( 6 ); and between inhalation volume and DM in patients with amyotrophic lateral sclerosis ( 16 ). Moreover, other studies of patients with stroke have reported correlations between DT, thickness ratio, and diaphragm excursion and between FVC, FEV1, and peak expiratory flow ( 8 , 9 ).…”

“…Although it has been reported that the nonparalytic diaphragm increases its movement to compensate for the dysfunction of the paralytic diaphragm, the compensation remains insufficient, resulting in a decrease in the vital capacity of patients with stroke ( 3 , 19–21 , 25 ). In addition to the diaphragmatic muscle, other accessory respiratory muscles, such as the sternocleidomastoid, serratus anterior, and intercostal muscles, may be temporarily or permanently deactivated owing to brain damage ( 5 ).…”

“…Diaphragmatic ultrasound is a commonly used method for measuring diaphragmatic activity. Previous studies have reported a certain relationship between diaphragmatic ultrasound indices and pulmonary function parameters in some diseases, including osteoporosis, vertebral fracture, kyphosis, late-onset Pompe disease, and amyotrophic lateral sclerosis ( 5–7 ). To the best of our knowledge, only two studies have reported the correlation between pulmonary function indices and diaphragmatic ultrasound in patients with stroke to date.…”

Does Adult Spinal Deformity Affect Cardiac Function? A Prospective Perioperative Study

“…Consequently, the mobility of the diaphragm would be impaired. Indeed, Ciloglu et al 41 reported that the diaphragm became thinner and softer at end-inspiration in cases of spinal hyperkyphosis. Moreover, the imposition of negative intrathoracic pressure, caused by diaphragm dysfunction,42 resulted in a reduction in LVEF 43…”

“…Consequently, the mobility of the diaphragm would be impaired. Indeed, Ciloglu et al 41 reported that the diaphragm became thinner and softer at Copyright r 2023 Wolters Kluwer Health, Inc. All rights reserved.…”