Haiying Liu

Study design: A prospective study. Objectives: This study aimed to evaluate the reliability and validity of ultrasound angles, and to explore the impact of body mass index (BMI) and scoliosis status on the accuracy of ultrasound measurements. Methods: A total of 94 subjects were enrolled in this study and subsequently underwent both X-ray and ultrasound examinations. Two orthopedic surgeons independently measured the radiographic Cobb angle and the ultrasound angle to evaluate the intra- and interobserver reliability of ultrasound angles. Based on apical vertebra location, BMI, and scoliosis status, subjects were stratified into clinically relevant subgroups. Linear regression analyses and Bland-Altman plots were employed to assess the accuracy of the ultrasound measurements. Results: Ultrasound angles demonstrated excellent intra- and interobserver reliability (intraclass correlation coefficients, ICCs ranging from 0.939 to 0.99), and manual ultrasound angle showed better correlation with the radiographic Cobb angle than the automatic ultrasound angle. The lowest R ² of 0.425 was observed for the automatic ultrasound angle in the overweight group, while manual ultrasound angle maintained comparable correlation with the Cobb angle across different BMI subgroups. Furthermore, a higher correlation was found between ultrasound angles and the Cobb angle in the scoliosis group compared to the non-scoliosis group. Conclusions: This study showed that ultrasound angles were reliable and valid. Manual measurements showed superior performance and should be prioritized. When using ultrasound angles to assess spinal curvature severity, the influence of BMI and scoliosis status must be considered.

Study Design: An Exploratory Study. Objectives: To estimate the prevalence of scoliosis and associated factors among adolescents, and to evaluate the clinical utility of an electronic scoliometer in school screening. Methods: The scoliosis school screening was conducted in Xinyang City, Henan Province, in 2024. Students’ study habits and daily routines were collected via questionnaires. Manual and electronic scoliometers were used for primary screening and compared using receiver operating characteristic (ROC) curves and agreement statistics. Three-dimensional ultrasound provided a provisional diagnosis. Multivariable logistic regression identified factors associated with scoliosis. Results: A total of 1874 students were enrolled in this study. The positive screening rates using manual and electronic scoliometers were 4.97% and 2.87%, respectively. Among these cases, 102 students were referred for 3D ultrasound examination, with 74 students showing an ultrasound Cobb angle ≥10°. The prevalence of scoliosis was 4.55% in seventh-grade students and 4.04% in eighth-grade students. The prevalence of scoliosis was 2.99% in males and 5.96% in females. In the paired sample (n = 39), the electronic device had an AUC of 0.844 (95% CI 0.718-0.971) vs 0.751 (95% CI 0.596-0.907) for the manual device (ΔAUC = 0.093, P = 0.033). Agreement for continuous ATR showed moderate absolute agreement (ICC(3,1) = 0.614; 95% CI 0.373-0.777). Multinomial regression identified sitting with crossed legs and lack of sports participation as potential risk factors. Conclusions: The prevalence of scoliosis among seventh and eighth-grade students in Xinyang City, Henan Province, was 4.33%. We recommend ATR ≥5°be triaged with 3D ultrasound before radiography; cases with UCA <20°should be rechecked at 3 months. Schools/parents should promote correct seated posture and more physical activity.

Study Design.: An exploratory study. Objective.: The purpose of this study is to investigate the prevalence of scoliosis in Linxia Prefecture, Gansu Province, China, and to explore the characteristics of electronic devices in scoliosis school screening (SSS). Background.: Forward bend test and scoliometer are common methods for SSS. The advantages of three-dimensional (3D) ultrasound system in SSS have been reported before. While there is a paucity of evidence to compare manual scoliometer (M-scoliometer) with electronic scoliometer (E-scoliometer), and the correlation between angle of trunk rotation (ATR) and ultrasound Cobb angle (UCA) is uncertain. Materials and Methods.: More than 27000 students in Linxia Prefecture, Gansu Province, China, were screened using M-scoliometer and E-scoliometer. Specifically, some students were screened before and after spinal motion test. Besides, one out of every 3 positive examinees would have their UCA measured. Their basic information and measurement results were recorded and analyzed. Results.: A total of 27532 students were included, whose informed consent forms were signed by their parents. The overall positive rate of primary screening was 2.27% (girls, 2.64%; boys, 1.91%; P < 0.001). There were no significant differences in positive rate between M-scoliometer and E-scoliometer ( P = 0.657). The screening speed of M-scoliometer was slower than that of E-scoliometer (36.53 vs . 19.19 s, P = 0.002). One-third of the positive students became negative after spinal motion test. Compared with the E-scoliometer group, the proportion of scoliosis in the M-scoliometer group was higher in degree I ( P = 0.046) and lower in degree II and III ( P = 0.01, P = 0.278). Moderate correlations were found between ATR and UCA (R ² = 0.245). Conclusions.: The overall positive rate of primary screening in this study is basically consistent with previous studies. We found that electronic scoliometer is as accurate as M-scoliometer, yet faster and more convenient. Besides, a moderate correlation exists between ATR and UCA. We believe that the introduction of electronic devices will make scoliosis screening radiation-free, more convenient, and efficient.

There are few researches on characterizing the sagittal alignment of degenerative thoracolumbar kyphosis (DTLK). In addition, the debate on the reasonable surgical strategies, for various patterns of DTLK, still continues. So, the study was to identify the features of DTLK, propose a novel classification of DTLK, and develop surgical strategies for this population. An overall 245 patients diagnosed with DTLK combined with lumbar stenosis performed surgeries (acquired satisfied) were selected from January 2016 to December 2022. The spino-pelvic measurements thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sagittal vertical axis (SVA) as well as the severe osteoporosis were recorded. To identify groups with similar spino-pelvic sagittal alignment parameters and clinical features, a 2-step cluster analysis was performed. Close relationships were found among the parameters. Four types of DTLK based on TLK and balance were classified with Type I: mild kyphosis and balance, Type II: mild kyphosis and imbalance, Type III: severe kyphosis and balance, Type IV: severe kyphosis and imbalance. The probability for imbalance with severe osteoporosis was 8.4 times higher than no osteoporosis (RR = 8.410). The probability for imbalance with PI-LL mismatch was 10 times higher than PI-LL matching (RR = 0.099 in Type II and RR = 0.103 in Type IV). For patients with DTLK, the TK was correlated with LL, PI-LL or PI in Type I to III group but not in Type IV group. Targeted treatment strategies for different types of patients was then addressed. We proposed a novel classifcation with four types of DTLK based on TLK and balance, followed by targeted treatment strategies for various types. Osteoporosis and lumbo-pelvic mismatch were risk factors for DTLK imbalance.

Objective: Ankylosing spondylitis (AS) is a debilitating rheumatic condition that significantly impairs mobility and quality of life through chronic inflammation and spinal fusion. The aim of this study is to investigate the optimal sequencing of spinal osteotomy and total hip replacement (THR) as treatment options, a topic that remains a subject of debate among medical professionals.Methods: In a retrospective cohort study spanning from 2017 to 2021, we assessed adult patients with AS who underwent both spinal osteotomy and THR, outcome measures involved radiographic assessments like Global Cobb angle, thoracolumbar kyphosis (TLK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS), as well as clinical metrics such as the Harris hip score. For the same surgical group, paired t‐tests were performed for pre‐ and postoperative data, while independent sample t‐tests were used for comparing different surgical groups. The study aims to elucidate the optimal sequencing of these surgical procedures based on these comprehensive metrics.Results: Among the 14 patients included, demographic and clinical variables were comparable between the two procedural groups. At the 3‐month follow‐up, all major metrics showed significant postoperative improvements. Specifically, the Global Cobb angle reduced from 98.88 ± 38.54 to 54.48 ± 18.14 (p = 0.018), and the Harris hip scores, evaluated at the 3‐month follow‐up, dramatically increased from 15.14 ± 10.12 to 72.57 ± 14.12 (p = 0.001). Furthermore, the Spine First Group exhibited more pronounced changes in pelvic parameters (p = 0.009), albeit at the expense of longer operation times and increased blood loss. No major complications were encountered.Conclusions: Contrary to the prevalent belief that spinal osteotomy should precede THR, our study argues that under certain conditions, opting for hip surgery first can be both viable and advantageous. This approach may mitigate the risk of complications and even facilitate subsequent spinal surgery. Surgical decisions must be highly tailored, focusing on patient‐specific needs and anatomical considerations. The ultimate goal remains consistent: to improve patients' functional abilities in daily activities and thereby enhance their overall quality of life.

Scoliosis is a complex three-dimensional torsional deformity in the spine and torso, with an established diagnostic criterion of a Cobb angle >10 degrees measured by Röntgen radiation (x-ray) [1]. Yet scoliosis in school children and adolescents is sometimes overlooked without periodic screening. Thus, treatment is usually recommended for them in the progressive period of the […]

Low back pain (LBP) is a symptom characterised by a range of biophysical, psychological, and social dimensions [1–3]. It is an extremely common symptom experienced by all ages, and it is the most common cause of years lived with disability (YLDs) globally [4]. In high-income countries, the prevalent health care approaches to LBP contribute to […]

Spinal abnormality surgery, including surgery for ankylosing spondylitis and idiopathic scoliosis, can present significant challenges to anesthesiologists because of the potential difficult airway. The bedside screening tests routinely used to detect difficult airways are highly variable. Pharynx volume calculated using three-dimensional (3D) computed tomography (CT) may play a role in predicting difficult airways. We conducted a retrospective cohort study on patients (aged ≥14 years) who received orthopedic surgery for ankylosing spondylitis/idiopathic scoliosis under general anesthesia. Volume of the pharynx air space was calculated through volume rendering technique by 3D reconstruction of patients’ cervical spine CT. Patients were divided into 2 groups according to their pharynx volume, pharyngeal volume lower than 16 mL (n = 11) and equal or higher than 16 mL (n = 13). Pharynx volume in low volume group was 10.4 ± 3.6 mL (n = 11), and the counterpart in high volume group was 20.8 ± 5.5 mL (n = 13). The incidence of difficult intubation was significantly higher in low pharynx volume group than in high pharynx volume group (54.5% (6/11) vs 7.6% (1/13), P = .023). Bedside screening tests including modified Mallampati test, inter-incisor gap and thyromental distance, or radiological variables such as anterior neck soft tissue thickness to vocal cords were not different between the 2 groups. Smaller pharynx volume played an important role in difficult airways for patients undergoing orthopedic surgery for ankylosing spondylitis/idiopathic scoliosis.