Background: Clinical decision-making in the treatment of foot deformities is based primarily on the results of the physical examination and the radiographic findings. The purpose of this study was to determine the validity and reliability of commonly used radiographic measurements of hindfoot valgus and varus deformities. Methods: Seventy-two patients with hindfoot deformity (thirty-six hindfoot valgus, mean age 15.5 years; thirty-six hindfoot varus, mean age 30.2 years) were evaluated. Nine representative indices on weight-bearing radiographs were assessed. Three examiners measured the radiographic indices at two sessions, and intraobserver and interobserver reliability was determined. Discriminant validity of the radiographic measurements between hindfoot valgus and varus was evaluated. The correlation with pedobarographic findings in evaluating the distribution of foot pressure during gait was assessed for convergent validity. Results: Naviculocuboid overlap, anteroposterior talonavicular coverage angle, anteroposterior talus-first metatarsal angle, calcaneal pitch angle, and lateral talus-first metatarsal angle showed excellent reliability. Naviculocuboid overlap, anteroposterior talonavicular coverage angle, and anteroposterior talus-first metatarsal angle showed excellent discriminant validity (in terms of effect-size r) and convergent validity (in terms of correlation coefficients with pedobarography). Conclusions: Naviculocuboid overlap, anteroposterior talonavicular coverage angle, and anteroposterior talus-first metatarsal angle are reliable and valid measures for the evaluation of hindfoot valgus and varus deformities. Level of Evidence: Diagnostic Level III. See Instructions to Authors for a complete description of levels of evidence.

Retrospective comparative study. To analyze changes in the clinical and radiological factors related to cervical sagittal balance, relative to preoperative T1 slope, in patients with cervical myelopathy after laminoplasty (LP). T1 slope is an important factor that should be considered before LP. However, until now, there have been no studies on how preoperative T1 slope affects the sagittal balance of cervical spine and various functional outcomes after LP. Seventy-six patients with cervical myelopathy (M:F ratio = 50:26; mean age = 64.7 ± 9.1 yr) underwent a cervical LP and were followed for more than 2 years. Radiological measurements were performed to analyze the following parameters: (1) C2-C7 sagittal vertical axis; (2) T1 slope; (3) C2-C7 lordosis; and (4) thoracic kyphosis. The visual analogue scale, Japanese Orthopedic Association, neck disability index, and 36-Item Short-Form Health Survey were also investigated. Patients were divided into 2 groups according to preoperative T1 slope, with the cutoff value being the median preoperative T1 slope. Changes in clinical and radiological parameters were compared between the preoperative evaluation and final visit. Overall, C2-C7 sagittal vertical axis increased from 21.2 to 24.5 mm (P = 0.004) and C2-C7 lordosis decreased from 13.9° to 10.3° (P = 0.007) postoperatively. The T1 slope did not show any postoperative differences. Preoperative C2-C7 lordosis was larger in the high-T1 group (19.1°) than in the low-T1 group (9.0°). However, postoperative changes in C2-C7 sagittal vertical axis and C2-C7 lordosis did not show any between-group differences. Clinical outcomes (except neck pain) demonstrated overall improvement in both groups. Comparing changes in both groups showed no differences in neck pain, arm pain, neck disability index, or 36-Item Short-Form Health Survey physical component score between groups. Cervical sagittal balance is compromised after cervical LP. However, the degree of aggravation does not correlate with the preoperative T1 slope. Most clinical parameters demonstrate overall improvement regardless of preoperative T1 slope. 3.

The contribution of preoperative embolization in reducing intraoperative blood loss and its clinical importance are unclear. So, we aimed to compare the perioperative clinical outcomes based on whether preoperative embolization was performed and assess the role and safety of preoperative embolization in metastatic spinal cord compression (MSCC) patients. We enrolled 52 patients (men, 37; women, 15) who underwent palliative decompression for MSCC. Demographic data, neurologic status, surgery-related data (operation time, estimated blood loss, and transfusion), complications, and survival time were recorded. Patients were categorized based on whether they received preoperative embolization: groups E (embolization) (n = 18) and NE (non-embolization) (n = 34) and the clinical parameters were compared. Subgroup analysis was performed specifically for cases of hypervascular tumors (23/52, 44%). The transfusion degree was greater in the NE group (4.6 pints) than in the E group (2.5 pints, P = 0.025); the other parameters did not differ between the groups. However, massive bleeding (>2000 mL) was more frequent in the NE group (10/34) than in the E group (0/18, P = 0.010). Subgroup analysis indicated that intraoperative blood loss was greater in the NE group (1988 mL) than in the E group (1095 mL, P = 0.042) in hypervascular tumor patients. Although massive bleeding was more frequent among hypervascular tumor patients, 3 patients with non-hypervascularized tumors also exhibited massive bleeding (P = 0.087). Intraoperative blood loss and perioperative transfusion can be reduced by preoperative embolization in MSCC patients. Neurologic recovery, operation time, and complications did not differ according to the application of embolization. As preoperative embolization is relatively safe and effective for controlling intraoperative bleeding without any neurologic deterioration, it is highly recommended for hypervascular tumors. Moreover, it may also be effective for non-hypervascular tumors as massive bleeding may be noted in some cases.