Lateral X-ray Research Articles

Examining the Utility of Lateral Neck X-Rays in Pediatric Otolaryngology.

The utility of lateral neck X-rays is unclear in pediatric otolaryngology. Past research showed that lateral neck X-ray did not change treatment decisions for children with suspected foreign body aspiration. This study examines the utility of lateral neck X-ray for patients also receiving otolaryngology consults for any indication. This is a retrospective chart review of pediatric patients between 2012 and 2022 who received a lateral neck X-ray for any indication and an otolaryngology consultation at a tertiary pediatric hospital. X-ray indication, diagnosis, and influence on interventional decisions were recorded from chart review. Of patients who received lateral neck X-rays, 494 patients (8.17%) also had an otolaryngology consult. Average patient age was 3.15 years. The most common indications for X-ray were foreign body aspiration (22%), croup (21%), breathing difficulties (20%), abscess or retropharyngeal infection (7%), and upper airway obstruction (5%). Lateral neck X-ray changed the Otolaryngologist's decision in 15% of patients. Intervention occurred in 25% of Otolaryngology consults, and this decision was never based on the X-ray. Lateral neck X-ray is unlikely to change Otolaryngology management. It is least indicated in patients presenting with concern of abscess and foreign body aspiration. Consultation with Otolaryngology before ordering diagnostic testing for those presenting with breathing difficulties, croup and upper airway obstruction may have cost savings and prevent unnecessary radiation exposure.

Effect of core stabilization exercises on cervical sagittal balance parameters in patients with forward head posture: a randomized controlled trial in Egypt.

A randomized controlled trial using a pretest-posttest control group design. This study investigated the effects of core stabilization exercises (CSEs) on cervical sagittal vertical alignment (cSVA), Cobb's angle, and Neck Disability Index (NDI) scores in patients with forward head posture (FHP). FHP is a local poor neck posture. However, it is frequently caused by sagittal lumbopelvic malalignment. Therefore, an alternative view by which we can begin proximal neuromuscular control is necessary. This study included 36 patients with FHP with a mean age of 27±2.63 years. These patients were randomly assigned to the two following groups: experimental group A (n=19), which received CSEs and postural correctional exercises (PCEs), , and control group B (n=17), which received only the PCE program. Randomization was performed using the computer-generated block randomization method. Training was applied 3 times per week and lasted for 6 weeks. Data were collected before and after training using lateral view cervical X-ray and NDI. Two-way mixed-design multivariate analysis of variance revealed significant improvements in mean cSVA and NDI values after training (p <0.05) in experimental group (A) compared with pre-training values, whereas no significant differences in these values were observed after training in the control group. In contrast, no significant difference in the mean Cobb angle values after training was observed between the groups. Adding CSEs to PCEs is more effective than performing PCEs alone for managing FHP. The trial was registered in the ClinicalTrials. gov registry under the registration number NCT06160245.

The role of paraspinal muscle degeneration in cervical spondylosis.

To explore the relationship between paraspinal muscle degeneration and cervical spondylosis through cervical spine MRI and lateral X-ray. A retrospective study included 83 cervical spondylosis patients as the experimental group, consisting of 28 axial joint pain (Group A), 29 cervical radiculopathy (Group B), and 26 myelopathy (Group C), as well as 29 healthy individuals as the control group (Group D). The cross-sectional area (CSA) of paraspinal muscles at the C3-4, C4-5, and C5-6 segments was measured, including the deep extensor area (DEA), deep flexor area (DFA), and superficial extensor area (SEA). Additionally, fatty infiltration (FI) ratio was calculated, namely the deep extensor fatty infiltration ratio (DEFIR), deep flexor fatty infiltration ratio (DFFIR), and superficial extensor fatty infiltration ratio (SEFIR). Correlations of CSA and FI ratio with age, body mass index, Pfirrmann grading, and Cobb angle were analyzed. (1) Pfirrmann grading in groups A, B, and C was significantly higher than that in group D (P < 0.001), with group C higher than groups A and B (P < 0.05), but the difference between groups A and B was not statistically significant (P > 0.05). (2) There was no significant difference in the CSA among groups (P > 0.05). For DEFIR and DFFIR, group C > group B > group A > group D, with significant differences (P < 0.05). For SEFIR, groups A, B, and C were significantly higher than group D (P < 0.001), with no significant differences between the other pairs (P > 0.05). (3) The CSA of males was significantly greater than females (P < 0.001), while the difference in FI ratio was not significant (P > 0.05). (4) In the control group, DEFIR and DFFIR were positively correlated with age (r = 0.538, P = 0.003; r = 0.829, P < 0.001) and negatively correlated with Cobb angle (r=-0.523, P = 0.004; r=-0.535, P = 0.003). In the experimental group, DEFIR and DFFIR were positively correlated with age (r = 0.731, P < 0.001; r = 0.741, P < 0.001) and Pfirrmann grading (r = 0.778, P < 0.001; r = 0.812, P < 0.001), and negatively correlated with Cobb angle (r=-0.507, P < 0.001; r=-0.539, P < 0.001). There were no correlations between the other parameters. In cervical spondylosis patients, the FI ratio of the deep cervical muscle is linked to both worsening disc degeneration and changes in cervical spine alignment. Among the different subtypes, cervical myelopathy shows the highest FI ratio of the deep cervical muscle and disc degeneration, indicating its significant impact on spinal structure and muscular integrity.

Higher bone cement volume in total knee arthroplasty lowers the risk of postoperative radiolucent lines.

>The aim of this multicenter study was to analyze the potential impact of patient demographics and cementation technique towards the development of radiolucent lines (RLLs) in primary total knee arthroplasty (TKA). It was hypothesized that cementation techniques, including higher cement volume, double-layer cementation technique and hardening in full extension, reduce RLL incidence by improving stability, whereas demographic factors such as age, BMI and smoking may increase RLL risk by affecting bone quality and mechanical loading. Altogether, 776 patients (median age: 70.7 years; 39.2% males) underwent TKA at five tertiary orthopaedic centres between 11/2013 and 04/2023. X-rays were analyzed retrospectively for the evaluation of RLLs taken between 6 and 36 months from surgery. RLLs on anterior-posterior and lateral X-rays taken at a median of 14 months (range: 6-36) from primary surgery were evaluated using the Knee Society roentgenographic evaluation and scoring system. Potential associations of demographics and cementation technique on the occurrence of RLLs during follow-up were analyzed with uni- and multivariate logistic regression models. The overall incidence of RLLs around the TKA amounted to 37.4% (n = 290), with the tibial component (29.4%) being more commonly affected than the femoral component (15.0%). Patient age, gender, BMI and smoking habits were not significantly associated with higher incidence of RLLs (p > 0.05). The amount of cement used (odds ratio: 0.99; 95% confidence interval: 0.98-0.99; p = 0.028) was independently associated with a lower incidence of RLLs, irrespective of the double- versus single-layer cementation technique, cement hardening in full extension and time required for the X-ray. No influence of demographic data on the incidence of RLL was found, yet specific cementation techniques appeared beneficial. Future studies with longer follow-up periods are required to provide further insight into the herein-made preliminary findings and to assess potential associations with long-term aseptic loosening rates. Level III, retrospective observational study.

Relationship between diffuse idiopathic skeletal hyperostosis and lumbar paravertebral muscle fat infiltration: a CT-based retrospective study.

Plentiful evidence points to a significant correlation between paravertebral muscles and spinal diseases. Yet, no reports are available detailing the association between paravertebral muscle status and diffuse idiopathic skeletal hyperostosis (DISH). The purpose of this retrospective study was to assess the link between paravertebral muscle area as well as fat infiltration and DISH based on computer tomography. Data were obtained from patients with acute vertebral fractures who presented to a single spine center. All participants had whole spine lateral x-ray radiography for DISH diagnosis. Those with a history of spinal disease, fusion surgery, or tumors were excluded. Patients with or without DISH were propensity-matched by age, sex, and body mass index (BMI). Appropriate Mann-Whitney U-tests or independent t-tests were performed to evaluate the correlation between muscle area or fat infiltration of the L3 level paravertebral muscles and DISH. A total of 114 DISH and 114 non-DISH patients were assessed. The fat infiltration in the paravertebral muscles was remarkably higher in the DISH group than in the non-DISH (p < 0.05), whereas there was no statistical difference in the muscle area of the two (p > 0.05). In conclusion, the fat infiltration of the paravertebral muscles was significantly associated with DISH.

Efficacy and Risks of Posterior Vertebral Column Resection in the Treatment of Severe Pediatric Spinal Deformities: A Case Series.

Background/Objectives: Surgery for adolescent idiopathic deformities is often aimed at improving aesthetic appearance, striving for the best possible correction. However, severe and rigid scoliotic curves not only present aesthetic issues but can also compromise cardiopulmonary health and cause early neurological impairment due to spinal cord compression, posing significant risks of morbidity and mortality if untreated. Conservative treatments are ineffective for severe curves, defined by scoliotic angles over 70° and flexibility below 30% on lateral bending X-rays. Treatment often requires invasive interventions, such as osteotomies and vertebral resections. In particular, posterior vertebral column resection (PVCR) has shown effectiveness in realigning vertebral structures in complex cases. This study describes the efficacy and risks of PVCR through a series of cases treated at our institution. Methods: This case series was conducted at the Rizzoli Orthopedic Institute in Bologna, involving eight pediatric patients with severe, rigid spinal deformities, operated upon between 2018 and 2023. The underlying pathologies included idiopathic kyphoscoliosis, neurofibromatosis type 1, Pott's disease, and other congenital anomalies. Preoperative assessment included standard radiographs, magnetic resonance imaging, and computed tomography. During PVCR, motor and sensory evoked potentials were monitored to minimize neurological injury risk. Postoperative management included blood transfusions, antibiotic support, and early physiotherapy. Results: PVCR resulted in an average reduction in the Cobb angle from 86.3° preoperatively to 22.4° postoperatively, with a mean correction of 64%. The mean duration of the procedures was 337.4 min. Three patients had an uneventful postoperative course, while five developed complications, including infections and temporary neurological deficits, which were successfully managed. One patient developed an epidural hemorrhage that required emergency surgery for hematoma evacuation, with partial recovery. This study demonstrates the potential of PVCR for correcting rigid spinal deformities, highlighting the importance of postoperative management to minimize the associated risks. Conclusions: Posterior vertebral resection techniques offer significant promise in the correction of pediatric spinal deformities. Although ours is a small case series, it can provide important data for such treatment. Long-term monitoring is needed to fully understand the impact of these procedures and to further refine surgical techniques.

Anterior femoral offset is a flawed measurement of patellofemoral overstuffing

BackgroundPatellofemoral joint (PFJ) issues after total knee arthroplasty (TKA) are becoming a topic of interest once again. Due to the complex three-dimensional shape of the trochlea, various two-dimensional proxy measurements on plain X-rays have been described. One of these measurements is the anterior femoral offset (AFO). It is the distance between the anterior femoral cortex and the trochlea’s most anterior point (MAP) on a true lateral X-ray after TKA. Because the relationship between the trochlea’s MAP and its groove, which is the primary joint surface articulating with the patella, is unknown, the purpose of this study was to measure the distance between the MAP and the trochlear groove.MethodsAfter femoral component implantation, the surgeon identified the trochlea’s MAP and the trochlear groove in ten consecutive TKAs and measured their distance. Measurements were performed with a ruler on a true lateral photograph and with a radiographic marker on a lateral radiograph in four different knee flexion angles, according to a previously published protocol.ResultsThe trochlear groove had a mean distance from the MAP between 2.09 ± 0.15 and 5.50 ± 0.17 mm, depending on the position. In no case is the trochlear groove visible on a true lateral view.ConclusionOn a true lateral X-ray, the trochlea’s MAP omits the trochlear groove. Because the patella primarily articulates with the trochlear groove and because the relationship between the MAP and the trochlear groove is variable depending on the knee flexion angle, any conclusions regarding overstuffing based on a postoperative lateral knee X-ray are flawed.

Association between dental agenesis and facial morphology. A cross-sectional study in France.

Knowing the features of dental evolution and facial morphology, marked by an increase in the prevalence of agenesis and a tendency towards verticalization of the face, the main objective of this cross-sectional observational study was to assess the correlation between the occurrence of agenesis (of 3rd molars or other teeth) and facial morphology in the French population. The study was conducted at the University Hospital of Rennes, France, from June 2022 to October 2022. Patients aged 12-18 years who underwent a global orthodontic assessment were included. Data collected from medical examinations, panoramic, anteroposterior, and lateral x-rays were analyzed for cephalometric and dental features. The association between morphological parameters and agenesis of wisdom teeth or other teeth was assessed by univariate and multivariate analysis. The study included 259 patients, of whom 89 presented agenesis. Logistic regression analyses identified several morphological parameters associated with agenesis. In the multivariate model, a negative correlation was found between tooth agenesis and FMA (OR = 0.85; p < 0. 001), facial axis (OR = 0.92; p = 0.040), and a positive one with SNB (OR = 1.17; p = 0.023), ANS-Xi-Pm (OR = 1.12; p = 0.013). This study highlights the correlation between agenesis occurrence and specific cephalometric parameters in the French population. The findings suggest that transverse constriction of the maxilla, facial divergence, and anterior projection of the chin symphysis are associated with agenesis. Trial registration number: Opinion n°22.103, dated 06.04.2022.

December 2024 Medical Image of the Month: An Endobronchial Tumor

No abstract available. Article truncated after 150 words. A 61-year-old woman was for wheezing. She reported that the symptoms were sudden in onset and persisted for 2 months without improvement. There was no infectious prodrome, no history of an aspiration event, and the symptoms had no exacerbating or relieving factors. The patient reported a past medical history of reflux (controlled on omeprazole), dyslipidemia, hypertension, and migraine headaches. Her past surgical history includes remote histories of breast augmentation, hysterectomy and salpingo-oophorectomy, cholecystectomy, and urethral sling. The patient was a never-smoker with no history of illicit drug use, travel, or exposures. Family history was non-contributory. The patient medications included Crestor, Thiazide, Imitrex, Losartan, and Omeprazole. No known drug allergies. Her vital signs were normal. Physical exam demonstrated an inspiratory wheeze which was diffuse and best appreciated anteriorly. A PA and Lateral chest x-ray was done at the time of initial referral (Figure 1). A CT scan was subsequently obtained (Figure …

Development of a deep learning model for automatic detection of narrowed intervertebral disc space sites in caudal thoracic and lumbar lateral X-ray images of dogs.

Intervertebral disc disease is the most common spinal cord-related disease in dogs, caused by disc material protrusion or extrusion that compresses the spinal cord, leading to clinical symptoms. Diagnosis involves identifying radiographic signs such as intervertebral disc space narrowing, increased opacity of the intervertebral foramen, spondylosis deformans, and magnetic resonance imaging findings like spinal cord compression and lesions, alongside clinical symptoms and neurological examination findings. Intervertebral disc space narrowing on radiographs is the most common finding in intervertebral disc extrusion. This study aimed to develop a deep learning model to automatically recognize narrowed intervertebral disc space on caudal thoracic and lumbar X-ray images of dogs. In total, 241 caudal thoracic and lumbar lateral X-ray images from 142 dogs were used to develop and evaluate the model, which quantified intervertebral disc space distance and detected narrowing using a large-kernel one-dimensional convolutional neural network. When comparing veterinary clinicians and the deep learning model, the kappa value was 0.780, with 81.5% sensitivity and 95.6% specificity, showing substantial agreement. In conclusion, the deep learning model developed in this study, automatically and accurately quantified intervertebral disc space distance and detected narrowed sites in dogs, aiding in the initial screening of intervertebral disc disease and lesion localization.

Management of Acute Lateral Humeral Condyle Fractures in Children.

Pediatric elbow fractures are quite common, accounting for up to 34% of bone fractures in children. Among these, acute lateral humeral condyle (LHC) fractures represent up to 22%. The accurate diagnosis and early treatment of LHC fractures are crucial due to the potential for abnormal growth and significant long-term impacts on joint motion. With the aim of enhancing the understanding of pediatric LHC fracture management among pediatric healthcare practitioners, we present a literature review combined with our technical recommendations based on our experience. Imaging through AP, lateral, and internal oblique X-rays remains the gold standard for diagnosis, although there is increasing focus on non-irradiating techniques, considering the skeletally immature nature of the patients. Several classification systems aid in fracture assessment, each varying in their simplicity, reproducibility, and inter- and intra-observer correlations. The treatment approaches for LHC fractures include conservative management with immobilization for minimally displaced fractures and surgical intervention for displaced fractures. The surgical options encompass closed and open reductions, using Kirschner wires or cannulated screws for fixation. While both methods show favorable outcomes, recent years have seen a growing interest in expanding the traditional indications for closed approaches. After a period of post-surgical immobilization of the limb, rehabilitation care is recommended to assist in the recovery of the range of motion. During the postoperative period, the most frequent complications are bony overgrowth, malunion, and infection, although with highly variable rates, which typically do not result in functional impairment if managed properly. Regular follow-up and monitoring are essential for optimal recovery and minimizing long-term complications.

Up versus down: Does cuff spine orientation affect early adherence to upper airway stimulation?

Upper airway stimulation (UAS) is a treatment option for moderate-to-severe OSA, in which electrical stimulation is applied to the hypoglossal nerve via an electrode cuff. In this study, we assess the effect of electrode cuff positioning on UAS outcomes, in particular device adherence. Patients at a single academic institution who met the Food and Drug Administration criteria for UAS between 2016 and 2021 were included. The electrode position was documented as superior (cuff spine up) or inferior (cuff spine down) to the hypoglossal nerve based on postoperative lateral neck X-ray. Patients underwent titration polysomnography 2-6months following surgery. The most recent postoperative variables from sleep studies following titration polysomnogram were used for statistical analysis.Adherence data was downloaded from the UAS device. 327 patients met inclusion criteria. The average age of patients was 60.9 ± 11.1years, with 105 (32.1%) females. Cuff spine up position was present in 169 (51.7%) patients as compared to 158 (48.3%) with cuff spine down. UAS adherence was significantly higher among cuff spine down patients (45.4 vs. 41.0h device use/week, p = 0.015). Cuff position was not significantly associated with therapeutic amplitude, change in apnea hypopnea index, or change in symptoms as measured by the Epworth Sleepiness Scale. On multivariable linear regression analysis, cuff spine down position (β = 3.7, CI [1.3, 7.4], p = 0.038) and increased age (β = 0.22, CI [0.07, 0.38], p = 0.005) were associated with increased adherence. UAS cuff spine down position is associated with increased device adherence. Further investigation into cuff positioning is warranted.

Application of Solis fusion device in adjacent segment degeneration revision after anterior cervical discectomy bone grafting fusion

To observe the early clinical efficacy of the zero-remember cervical Solis fusion device in the treatment of adjacent segment degeneration(ASD) revision after anterior cervical discectomy and fusion(ACDF). A retrospective analysis was performed for 13 patients with adjacent spondylosis after anterior cervical discectomy bone graft fusion with Solis fusion device, including 5 males and 8 females, aging from 56 to 78 years old. The patients had intractable neck pain or superficial paresthesia of upper extremities before operation, and the effect of conservative treatment was not good. The operation time, intraoperative blood loss and postoperative complications were recorded. Before operation, 1 week postoperative and final follow-up, the visual analogue scale(VAS) and Japanese Orthopaedic Association(JOA) scores were used to assess clinical efficacy. X-ray and CT of the cervical spine were performed to measure and evaluate the height of the intervertebral space and intervertebral fusion. All patients were followed up from 18 to 36 months. All 13 patients successfully completed revision surgery with single gaps. The operation time was 63 to 93 min, the intraoperative blood loss was 15 to 83 ml. The pain VAS was reduced from 4 to 7 points before surgery to 1 to 3 points at 1 week and 1 to 2 points at the final follow-up. The height of the intervertebral space was increased from 5.2 to 7.2 mm before surgery to 6.4 to 8.0 mm at 1 week after surgery and 6.4 to 7.9 mm at the final follow-up. The JOA score was increased from 11 to 17 points before surgery to 13 to 17 points at 1 week after surgery and 16 to 17 points at the final follow-up visit. At the final follow-up, AP and lateral X-ray films of cervical spine showed homogeneous bone fusion of the Solis fusion. One patient developed transient left upper limb weakness after surgery, which recovered at follow-up, and all patients had no dysphagia, incision hematoma or infection, and displacement. The early clinical efficacy of Solis fusion device in the treatment of orthospondylosis after anterior cervical intervertebral fusion is satisfactory, and it has the advantages of less surgical trauma, adequate decompression, high osseointegration rate and fewer complications, which can provide a new option for minimally invasive treatment of orthospondylosis after cervical spine surgery.

Application of modified tibial extramedullary localization technique in Link-Sled prosthesis for unicompartmental knee arthroplasty and its clinical efficacy

To explore clinical effect of modified tibial extramedullary localization technique applied to unicompartmental knee arthroplasty(UKA) in patients with single compartment osteoarthritis. From May 2018 to February 2022, 75 patients with single-compartment osteoarthritis of knee joint (33 males and 42 females) were treated with modified tibial extramedullary localization technique UKA, aged from 52 to 73 years old with an average of (64.0±6.0) years old;the course of disease ranged from 0.5 to 11.0 years with an average of (3.2±2.7) years;31 patients on the left side, 37 patients on the right side and 7 patients on both sides. The position of prosthesis was evaluated by AP and lateral X-ray of knee joint and postoperative complications were observed. Visual analog scale(VAS) and Hospital for Special Surgery(HSS) of knee score were compared before and 1 year after operation. Forgotten joint score(FJS) was used to evaluate degree of amnesia at 1 year after operation. Seventy-five patients were followed up for 12 to 15 months with an average of (13.0±1.5) months. Postoperative complications were occurred in 2 patients, of which 1 patient was superficial incision infection, which healed after dressing change. One patient was developed intraarticular bleeding at 1 month after operation, which was improved after arthroscopic cleaning. VAS was decreased from (6.4±0.9) before operation to (2.3±0.3) at 1 year after operation (P<0.01), and HSS was increased from (65.2±7.5) before operation to (92.8±5.3) at 1 year after operation (P<0.01). FJS score at 1 year after operation was (70.5±2.3), indicating that the sensation of knee joint after operation was close to proprioception. UKA has definite clinical effect on single-compartment osteoarthritis, which could reduce postoperative pain, improve knee joint function, and is the main surgical treatment for single-compartment osteoarthritis. The modified tibial extramedullary localization technique could be used to locate osteotomy direction and prosthesis position more conveniently and accurately during operation, and obtain good clinical effect.

Accuracy and reliability of the AO/OTA classification for tibial shaft fractures

BackgroundAvailable literature lacks information regarding the accuracy and reliability of the AO/OTA classification for tibial shaft fractures. This study aimed to assess the inter- and intra-observer agreement and accuracy of the AO/OTA 42 classification (4-signs) for adult patients with tibial shaft fractures. Materials and methodsThe study design is an accuracy, inter- and intra-observer agreement study. Anterior posterior (AP) and lateral X-rays of the fracture were used in the examination. The raters comprised of two junior doctors and two orthopedic trauma consultants, who underwent patient scoring twice in a blinded and randomized set-up. A committee including two consultant orthopedic trauma surgeons, one consultant orthopedic radiologist, and one associate professor was established to represent the “gold standard.” The 3- and 4-signs AO/OTA 42 classification was used for classification. ResultsA total of 101 patients were included. X-rays were available for all 101 patients. Based on the gold standard classification, AO/OTA 42-A1 (56 %) was the most common fracture type, followed by AO/OTA 42-A3 (14 %). The agreement at 4-signs, when comparing the four raters and the gold standard classification was between 75 % and 86 % (Choen's kappa 0.53 to 0.79). Choen's kappa coefficient at 4-sgns for intra-and inter-observer agreement was between 0.47 and 0.74 and 0.31 and 0.60, respectively. ConclusionThis study showed substantial to moderate accuracy of the 4-signs AO/OTA 42- classification for tibial shaft fractures. Intra-observation agreements at 4-signs showed moderate to substantial agreement with and without available CT scans. Inter-observer agreements at 4-signs showed moderate to substantial agreement with only X-rays available. Inter-observer agreements for CT scan at 4-signs showed slight to moderate agreements.

Comparative efficacy of anteroposterior and lateral X-ray based deep learning in the detection of osteoporotic vertebral compression fracture

Magnetic resonance imaging remains the gold standard for diagnosing osteoporotic vertebral compression fractures (OVCF), but the use of X-ray imaging, particularly anteroposterior (AP) and lateral views, is prevalent due to its accessibility and cost-effectiveness. We aim to assess whether the performance of AP images-based deep learning is comparable compared to those using lateral images. This retrospective study analyzed X-ray images from two tertiary teaching hospitals, involving 1,507 patients for the training and internal test, and 104 patients for the external test. The EfficientNet-B5-based algorithms were employed to classify OVCF and non-OVCF group. The model was trained with a 1:1 balanced dataset and validated through 5-fold cross validation. Performance outcomes were compared with the area under receiver operating characteristic (AUROC) curve. Out of a total of 1,507 patients, 799 were included in the training dataset and 708 were included in the internal test dataset. The training and internal test datasets were matched 1:1 as OVCF and non-OVCF patients. The DL model showed comparable classifying performance with internal test data (N = 708, AUROC for AP, 0.915; AUROC for lateral, 0.953) and external test data (N = 104, AUROC for AP, 0.982; AUROC for lateral, 0979), respectively. The other performances including F1 score and accuracy were also comparable. Especially, The AUROC of AP and lateral x-ray image-based DL was not significantly different (p for DeLong test = 0.604). The EfficientNet-B5 algorithms using AP X-ray images shows comparable efficacy for classifying OVCF and non-OVCF compared to lateral images.

Effectiveness of unilateral biportal endoscopy technique combined with percutaneous pedicle screw fixation in treatment of lumbar burst fractures

To compare the effectiveness of unilateral biportal endoscopy (UBE) technique assisted spinal canal decompression combined with percutaneous pedicle screw internal fixation versus traditional open decompression and internal fixation for treatment of lumbar burst fractures. A retrospective study was conducted on the clinical data of 61 patients with single-segment lumbar burst fractures who met the selection criteria and were admitted between October 2022 and December 2023. Of them, 25 patients received UBE technique assisted decompression combined with percutaneous pedicle screw fixation (UBE group), while 36 patients were treated with traditional posterior unilateral hemilaminectomy decompression and internal fixation (open group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, body mass index, fracture segment, cause of injury, AO classification of lumbar fractures, and preoperative height ratio of the anterior margin of injured vertebra, segmental kyphosis angle, rate of spinal canal invasion, the classification of American Spinal Injury Association (ASIA) grading, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. VAS score, ODI, and ASIA grading were used to evaluate the effectiveness before operation, at 1 week after operation, and at last follow-up. Lumbar anteroposterior and lateral X-ray films and CT were performed to measure the segmental kyphosis angle, height ratio of the anterior margin of injured vertebra, and the rate of spinal canal invasion. Surgery was successfully completed in both groups. No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. There was no significant difference in operation time between the two groups ( P>0.05), the UBE group revealed significant less intraoperative blood loss when compared with open group ( P<0.05). Patients in both groups were followed up 6-20 months, with an average of 13 months. There was no loosening, breakage, or failure of internal fixation in all patients. The ASIA grading, VAS score, ODI of the two groups significantly improved at 1 week after operation and further improved at last follow-up ( P<0.05). There was no significant difference in ASIA grading at 1 week after operation and last follow-up between the two groups ( P>0.05), but the VAS score and ODI in the UBE group were significantly superior to the open group ( P<0.05). At 1 week after operation, the height ratio of the anterior margin of injured vertebra, segmental kyphosis angle, rate of spinal canal invasion significantly improved when compared to preoperative ones ( P<0.05), the height ratio of the anterior margin of injured vertebra and segmental kyphosis angle significantly decreased at last follow-up when compared to the values at 1 week after operation ( P<0.05), but the rate of spinal canal invasion was further significantly improved, and there was no significant difference between the two groups at different time point postoperatively. UBE technique assisted spinal canal decompression combined with percutaneous pedicle screw fixation is a safe and effective treatment for lumbar burst fractures, which with little trauma and faster recovery when compared with traditional open decompression and internal fixation.

Changes in Upper Airway Space in a Patient with Pycnodysostosis Following Primary Surgery and Orthodontic Treatment: A 12-Year Follow-Up Case Report

Pycnodysostosis (PDS) is an autosomal recessive form of osteosclerotic skeletal dysplasia characterized by craniofacial anomalies, a high-arched palate, and a narrowed pharyngeal space due to mandibular and maxillary deficiencies. These structural anomalies in the upper airway predispose PDS patients to obstructive sleep apnea (OSA). OSA can be managed in PDS patients using either a conservative (non-surgical and multidisciplinary) approach or surgical interventions. Given the craniofacial anomalies associated with PDS, orthodontic treatment aims to address the maxillary transverse deficit and retrognathia. Currently, there is no evidence regarding the impact of orthodontic therapy on OSA levels among PDS patients. This study reports the long-term morphological and functional changes in the upper airway of a PDS patient following adenotonsillectomy and uvulopalatoplasty at an early age (3.6 years) and orthodontic camouflage in late mixed dentition (10 years). Polysomnographies (PSGs), nuclear magnetic resonance (NMR), and lateral cephalograms taken before and after ENT surgery and orthodontic treatment were analyzed. Lateral X-rays were evaluated for changes in the posterior airway space (PAS), while polysomnographies provided the apnea–hypopnea index (AHI). The NMR scans were segmented to measure the perimeter and radius of the upper airway. The findings of this study indicate that improvements following uvulopalatoplasty (UPP) were partial and temporary. Nonetheless, orthodontic therapy and the use of elastics did not appear to influence the PAS or AHI. Future studies with larger cohorts are needed to evaluate the long-term effectiveness of the UPP procedure. This study was conducted in accordance with the CARE guidelines.

What imaging does my AIS patient need? A multi-group survey of provider preferences.

Adolescent idiopathic scoliosis (AIS) is a common diagnosis managed by pediatric orthopedic surgeons with nonoperative radiographic monitoring representing a cornerstone of treatment. Differences in practices and techniques for obtaining radiographic studies contribute to variation, cost of care, and hamper data aggregation. We surveyed several large organizations dedicated to children's orthopedics or scoliosis care to obtain a consensus for radiographic evaluation of AIS. A REDCap-based survey was developed across four institutions and beta-tested by staff and fellows from a single institution. The finalized survey was distributed to members of POSNA, PSSG, and SOSORT, and shared on social media. Participants were asked to rank the importance of various datapoints in radiographic assessment of the spinal deformity, skeletal maturity, and study indications during initial, subsequent, preoperative, and final office visits for AIS. Response rate for the overall group was 26%. Cobb angle was considered the most important (> 94%) radiographic index across all time points. For positioning, 46% of respondents favored arms bent touching clavicles as the ideal positioning for X-rays, and another 24% favored arms down with palms forward (Table2). The majority of respondents obtain lateral X-rays at the first visit (99%) and at the preoperative visit (70%). At the preoperative visit, sagittal contour (86%), apex location (85%), and Lenke classification (73%) were considered important factors to record. Flexibility studies are primarily obtained at the preoperative visit (89%) and 81% of respondents prefer bending films as the flexibility technique of choice. Regarding measures of skeletal maturity, Sanders bone age was considered to be the most important by over 70% of respondents across initial, subsequent, preoperative and brace wean visits (Fig.2). MRIs were obtained routinely by 34% of respondents and only when the patient had a concerning symptom or finding for 67% of respondents. Despite large variations in radiographic examination of AIS, large areas of agreement were found. It is important to establish standards for positioning patients, evaluating skeletal maturity, and obtaining assessments including lateral views, flexibility studies, and advanced imaging. Establishing common practices for radiographic evaluation of AIS will allow for less variation in care and for critical questions to be answered through registry formation and large multicenter data collection. This study establishes current practitioner opinion on the radiographic evaluation of the AIS patient. Minimum data sets are useful for data aggregation and answering research questions in the face of data variability. Level V.

Use of Artificial Intelligence in Cobb Angle Measurement for Scoliosis: Retrospective Reliability and Accuracy Study of a Mobile App.

Scoliosis is a spinal deformity in which one or more spinal segments bend to the side or show vertebral rotation. Some artificial intelligence (AI) apps have already been developed for measuring the Cobb angle in patients with scoliosis. These apps still require doctors to perform certain measurements, which can lead to interobserver variability. The AI app (cobbAngle pro) in this study will eliminate the need for doctor measurements, achieving complete automation. We aimed to evaluate the reliability and accuracy of our new AI app that is based on deep learning to automatically measure the Cobb angle in patients with scoliosis. A retrospective analysis was conducted on the clinical data of children with scoliosis who were treated at the Pediatric Orthopedics Department of the Children's Hospital affiliated with Fudan University from July 2019 to July 2022. Three measurers used the Picture Archiving and Communication System (PACS) to measure the coronal main curve Cobb angle in 802 full-length anteroposterior and lateral spine X-rays of 601 children with scoliosis, and recorded the results of each measurement. After an interval of 2 weeks, the mobile AI app was used to remeasure the Cobb angle once. The Cobb angle measurements from the PACS were used as the reference standard, and the accuracy of the Cobb angle measurements by the app was analyzed through the Bland-Altman test. The intraclass correlation coefficient (ICC) was used to compare the repeatability within measurers and the consistency between measurers. Among 601 children with scoliosis, 89 were male and 512 were female (age range: 10-17 years), and 802 full-length spinal X-rays were analyzed. Two functionalities of the app (photography and photo upload) were compared with the PACS for measuring the Cobb angle. The consistency was found to be excellent. The average absolute errors of the Cobb angle measured by the photography and upload methods were 2.00 and 2.08, respectively. Using a clinical allowance maximum error of 5°, the 95% limits of agreement (LoAs) for Cobb angle measurements by the photography and upload methods were -4.7° to 4.9° and -4.9° to 4.9°, respectively. For the photography and upload methods, the 95% LoAs for measuring Cobb angles were -4.3° to 4.6° and -4.4° to 4.7°, respectively, in mild scoliosis patients; -4.9° to 5.2° and -5.1° to 5.1°, respectively, in moderate scoliosis patients; and -5.2° to 5.0° and -6.0° to 4.8°, respectively, in severe scoliosis patients. The Cobb angle measured by the 3 observers twice before and after using the photography method had good repeatability (P<.001). The consistency between the observers was excellent (P<.001). The new AI platform is accurate and repeatable in the automatic measurement of the Cobb angle of the main curvature in patients with scoliosis.