| Part 1 Low body mass index can be predictive of bracing failure in patients with adolescent idiopathic scoliosis:a retrospective studyPurposes To determine the relationship between low body mass index(BMI)and the outcome of brace treatment in patients with adolescent idiopathic scoliosis(AIS).Methods 350 braced female AIS patients were included in this study.The baseline characteristics of the patient were recorded at their first visit,including age,Risser sign,digital skeletal age,BMI,curve pattern,and curve magnitude.Underweight was defined as lower than the 5th percentile of the sex-and age-specific BMI.The treatment was considered as a failure if the curve progressed more than 5°,or if patients underwent surgery.According to the final outcome of brace treatment,the cohort was divided into the success group and the failure group.A logistic regression model was created to determine the independent predictors of the bracing outcome.Results 24.5%(86/350)of the patients were identified as underweight at their initial visit,which was significantly higher than the rate of 13.1%(46/350)at the final follow-up(p<0.001=.At the initial visit of the patients,the rate of underweight was 17.6%(45/255)in the success group,which was significantly lower than the rate of 43.1%(41/95)in the failure group(p<0.001 =.Logistic regression analysis showed that low BMI was significantly associated with bracing failure(p<0.001=.Conclusion The low BMI could be predictive of bracing failure in AIS patients,which should be taken into account when surgeons prescribe brace treatment to such patients.Part 2 Grayscale inversion radiographic view provided improved intra and interobserver reliabilities in measuring spinopelvic parameters in asymptomatic adult populationPurpose Recently,a grayscale inversion view was reported to improve intra-and inter-observer reliabilities in measuring coronal curvature with Cobb and pedicle methods in scoliosis patients.However,the grayscale transformation has never been applied to the measurements of spinopelvic parameters.The purpose of this study was to compare the measurement reliabilities of the spinoplevic sagittal parameters between the ’Standard View’ and the ’Grayscale Inversion View’ in normal adult populations.Methods A total of 30 asymptomatic subjects aged between 30 and 40 years were included in this study.Whole spine posteroanterior radiographs were used to measure the spinoplevic sagittal parameters including thoracic kyphosis(TK),lumbar lordosis(LL),sagittal vertical axis(SVA),pelvic incidence(PI),sacral slope(SS)and pelvic tilt(PT)in both standard view and grayscale inversion view.Two independent observers measured the parameters twice at a 2-week interval.Intra-and inter-observer reliabilities were compared between the two radiographic views.The absolute differences between the two sets of measurements on each view were calculated and compared.Results The intra-class correlation coefficients(ICCs)of PI,PT and SVA were greater in the grayscale inversion view than in the standard view(0.972 v.s.0.817,0.937 v.s.0.833 and 0.964 v.s.0.901 for observer 1,respectively;0.990 v.s.0.826,0.995 v.s.0.842 and 0.969 v.s.0.919 for observer 2,respectively).Overall,the improvement of ICC was greater in parameters of sagittal pelvic alignment than in those of sagittal spinal alignment.As for the mean absolute differences between two measurements,significant differences existed between the two views in terms of PI,PT and SVA(p = 0.014,0.016 and 0.011 for observer 1,respectively;p = 0.014,0.025 and 0.046 for observer 2,respectively).Conclusions A grayscale inversion view provided improved intra-and inter-observer reliabilities in measuring spinoplevic alignment when compared with a standard view.This view was more useful in subjects whose pelvic anatomical structures can’t be identified clearly on the standard X-ray view.Part 3 Grayscale inversion view can improve the reliability for measuring proximal junctional kyphosis in adolescent idiopathic scoliosisPurpose Proximal junctional kyphosis(PJK)is a relatively common phenomenon in AIS patients with long segmental fusion surgery.Identifying the proximal junctional angle(PJA)clearly is required to diagnose the PJK.The purpose of this study is to determine whether a grayscale inversion view can be used to measure PJA and assess PJK accurately.Methods A total of 162 AIS patients who underwent posterior spinal fusion surgeries were included in this study.PJA was measured on preoperative lateral standing films using the three commonly used methods(UIV+1,UIV+2,and UIV to T2)on both standard view and grayscale inversion view.Two independent physicians measured the PJA twice at a one-month interval.Intra-and inter-observer reliabilities were compared between the two radiographic views.Then forty patients with preoperative MRI images were randomly selected.PJA was measured in 40 patients on their MRI and lateral standing films on both views within three methods.The correlation coefficient between PJA obtained on MRI and PJA obtained on X-ray with different views were calculated respectively.Results The intra-class correlation coefficients(ICCs)which represent the intra-observer reliabilities were greater in a grayscale inversion view than in a standard view in all methods for both observers.And the ICCs of inter-observer reliabilities were also greater in a grayscale inversion view.The correlation coefficient between PJA obtained on grayscale inversion view and pre-operative MRI was higher in all methods compared with standard view.Conclusions The results of the current study suggested that grayscale inversion view can reduce the limitations of the three commonly used methods of measuring PJA and can be applied to measure PJA and assess PJK accurately. |
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