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 […]

Purpose: To compare sagittal alignment and clinical outcomes between three-level hybrid surgery (HS) and anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) over a 5-year follow-up. Method: The study included 32 patients with ACDF, 36 patients with 1 prosthesis and 2 cages (HS1 group), and 25 cases with 2 prostheses and 1 cage (HS2 group). Alignment parameters included C2–C7 cervical lordosis (CL), C2–C7 sagittal vertical axis (SVA), T1 slope (T1S), and T1S minus CL (T1SCL). Radiographic parameters were range of motion (ROM), upper and lower adjacent ROM (UROM and LROM), and operated-segment lordosis (OPCL), as well as adjacent segment degeneration (ASD). Clinical outcomes included the neck disability index (NDI) and Japanese Orthopedic Association (JOA) score. Results: Three groups were well-matched in demographics. All groups gained comparable improvement on NDI and JOA (P < 0.01). All groups gained CL improvement at the final visit (P < 0.05). There were no statistical differences on SVA and T1SCL among the groups and among preoperation, 1 week later, and final follow-up (P > 0.05) while T1S improved at 1 week later and final follow-up with HS2. The final change of all alignment parameters among the three groups was of no differences. ROM decreased and OPCL increased in all groups at the final follow-up (P < 0.05). UROM and LROM increased with ACDF but kept stable with HS1 and HS2. There was no inter-group difference on the incidence of ASD (P > 0.05). Conclusion: Cervical alignment was comparably improved. HS and ACDF provided identified mid-term efficacy, and it was not necessary to have to use prosthesis on three-level CSM.

Study Design.: Comparative study. Objective.: The aim of this study was to compare cervical alignment among three-level total disc replacement (TDR), two prosthesis with one cage (2D1C), one prosthesis with two cages (1D2C), and anterior cervical discectomy and fusion (ACDF), then identify the importance of cervical balance of cervical spondylotic myelopathy (CSM). Summary of Background Data.: There were few long-term comparisons on cervical alignment and cervical balance among three-level TDR, 2D1C, 1D2C, and ACDF for CSM. Methods.: Twenty-eight patients with TDR, 15 with 2D1C, 36 with 1D2C, and 32 cases with ACDF were included with a mean follow-up of 90.9 ± 8.9 months. C2-C7 cervical lordosis (CL), C2-C7 sagittal vertical axis (SVA), T1 slope (T1S) were measured on x-ray at preoperation, immediate postoperation, and final follow-up, as well as range of motion (ROM), upper/lower adjacent ROM (UROM/LROM), and adjacent segment degeneration (ASD); cervical balance was assessed by T1S minus CL (T1SCL; 20°). Clinical outcomes included neck disability index (NDI) and Japanese Orthopedic Association (JOA) score. Results.: NDI and JOA improved (P < 0.01)at postoperation and final-visit with no difference among four groups. ROM decreased mostly in ACDF group, although with a comparable inter-group UROM/LROM and ASD. All groups gained equal CL-improvement at final-visit. SVA and T1S together with their change were of no differences among groups (P > 0.05). There was a correlation among alignment parameters and between CL and ROM. The inter-group capacity of balance maintaining and imbalance correction was comparable (P > 0.05). The change of T1SCL was not correlated to NDI and JOA (P > 0.05). Conclusion.: Adjacent segments were seldom affected. Cervical alignment was equivalently rebuilt among TDR, 2D1C, 1D2C, and ACDF. It was not essential to pay excessive attention to balance. Level of Evidence: 3

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 […]

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.

As the technology of combining with fusion and nonfusion procedure, cervical hybrid surgery (HS) is an efficacious alternative for treatment with cervical spondylotic myelopathy. While studies on cervical alignment between 3-level HS and anterior cervical discectomy and fusion (ACDF) were seldom reported. The effects of cervical imbalance on its related clinical outcomes are yet undetermined as well. Patients with cervical spondylotic myelopathy, who underwent 3-level ACDF or HS, were included to compare cervical alignment parameters after surgery and then explore the relationship between cervical balance and clinical outcomes. Forty-one patients with HS (HS group) and 32 patients who with ACDF (ACDF group) were reviewed from February 2007 to September 2013 with the mean follow-up of 90.3 ± 25.5 (m) and 86.3 ± 28.9 (m), respectively. Cervical alignments parameters including the C2 to C7 cervical lordosis (CL), C2 to C7 sagittal vertical axis, T1 slope. and T1SCL (T1 slope minus CL), and the clinical outcomes like neck disability index (NDI) and Japanese Orthopedic Association (JOA) score were measured and recorded preoperatively (PreOP), intraoperatively, and on the first preoperative day and the last follow-up (FFU). The balance and imbalance groupings were sorted based on the T1SCL: T1SCL≤20°,balance; T1SCL > 20°, imbalance. We found significant improvements (P < .001) in NDI and JOA at intraoperatively and FFU after ACDF and HS, and no difference on cervical alignment and clinical outcomes between the 2 procedures on the basis of intergroup comparisons. By between-subgroups comparisons, however, we found significant differences in CL and T1SCL at PreOP (P < .05). Nonetheless, there was no significant difference on the clinical outcomes between balance and imbalance subgroups at FFU at PreOP (P > .05), indicating that the change of T1SCL was not correlated to NDI and JOA at FFU. Both HS and ACDF groups showed significant clinical improvements after surgery. There was no correlation between cervical balance and clinical symptoms.