Do patients with renal calculi exhibit viscerosomatic reflexes as evident on CT imaging?

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Abstract

Experimental evidence supporting the existence of the viscerosomatic reflex highlights an involvement of multiple vertebral levels when renal pathology is present. Further exploration of this reflex, particularly in the context of nephrolithiasis, could offer valuable insights for osteopathic treatments related to this pathology. Open-sourced machine learning datasets provide a valuable source of imaging data for investigating osteopathic phenomena including the viscerosomatic reflex. This study aimed to compare the rotation of vertebrae at levels associated with the viscerosomatic reflex in renal pathology in patients with nephrolithiasis vs. those without kidney stones. A total of 210 unenhanced computed tomography (CT) scans were examined from an open-sourced dataset designed for kidney and kidney stone segmentation. Among these, 166 scans were excluded due to pathologies that could affect analysis (osteophytes, renal masses, etc.). The 44 scans included in the analysis encompassed 292 relevant vertebrae. Of those, 15 scans were of patients with kidney stones in the right kidney, 13 in the left kidney, 7 bilaterally, and 11 without kidney stones. These scans included vertebral levels from T5-L5, with the majority falling within T10-L5. An open-sourced algorithm was employed to segment individual vertebrae, generating models that maintained their orientation in three-dimensional (3D) space. A self-coded 3D slicer module utilizing vertebral symmetry for rotation detection was then applied. Two-way analysis of variance (ANOVA) testing was conducted to assess differences in vertebral rotation between the four possible combinations of kidney stone location (left-sided, right-sided, bilateral, or none) and vertebral levels (T10-L4). Subsequently, the two-way ANOVA analysis was narrowed down to include various combinations of three vertebral levels (T10-L4) to identify the most significant levels. We observed a statistically significant difference in average vertebral rotation (p=0.0038) dependent on kidney stone location. Post-hoc analysis showed an average difference in rotation of -1.38° leftward between scans that contained left kidney stones compared to no kidney stones (p=0.027), as well as an average difference of -1.72° leftward in the scans containing right kidney stones compared to no kidney stone (p=0.0037). The average differences in rotation between the remaining stone location combinations were not statistically significant. Narrowed analysis of three vertebral level combinations showed a single statistically significant combination (T10, T12, and L4) out of a total of 35 combinations (p=0.028). A subsequent post-hoc procedure showed that angular rotation at these levels had the only statistically significant contribution to the difference between scans containing right kidney stones and no kidney stones (p=0.046). This study observed a statistically significant difference in the rotation of vertebrae at the levels associated with the viscerosomatic reflex between patients with unilateral kidney stones and those without kidney stones. The vertebral levels with the highest significance of association with this finding, particularly in right kidney stones, were T10, T12, and L4.

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