Objectives:To investigate the relationship between the improvement of lumbar symptoms and imaging parameters in patients with tandem spinal stenosis(TSS)primarily manifesting as cervical spondylotic myelopathy(CSM)after initial cervical decompression surgery,and to explore related imaging predictive factors.Methods:A retrospective analysis was conducted on 69 TSS patients who underwent primary cervical decom-pression surgery,with an average age of 64.3±10.5 years(ranging from 41 to 86 years old)and a follow-up period of 33.8±5.5 months(ranging from 24 to 48 months).Preoperative symptoms and signs,Nurick gait clas-sification,and preoperative and final follow-up Japanese Orthopaedic Association(JOA)scores for both the cer-vical and lumbar spine were recorded and analyzed.The patients were divided into an improvement group(n=37)and a non-improvement group(n=32)based on the improvement conditions of lumbar spine JOA scores at the final follow-up.Imaging parameters were measured including spinal cord compression ratio,cross-sectional area of the dural sac at the narrowest point of the cervical spinal cord,the ratio of the vertebral canal to the vertebral body and the actual spinal canal width from C3 to C7,and the actual width of the vertebral canal from L1 to L5.The conditions of spinal canal stenosis were evaluated according to the grading system of spinal canal stenosis of cervical and lumbar spine proposed by Lee et al,and the number of cervical verte-brae with a stenosis score ≥1,score at the narrowest part of cervical spinal canal,and the total score of cervical stenosis,as well as the number of lumbar vertebrae with a stenosis score ≥1,score at the narrowest part of lumbar spinal canal,and the total score of lumbar stenosis were calculated.Intergroup comparisons were performed using t tests,chi-square tests,and Mann-Whitney U tests.For the statistic data with statisti-cal differences between the two groups,receiver operating characteristic(ROC)curve was used to determine op-timal thresholds for each parameter,and the area under the ROC curve(AUC)and its corresponding 95％ con-fidence interval(CI)were calculated.Multivariate logistic regression analysis was conducted to identify radiolog-ical predictive factors for non-improvement of lumbar symptoms in TSS patients.Results:The non-improvement group was significantly higher than the improvement group in the total score of lumbar stenosis(5.00±1.68 vs 2.68±1.23,P＜0.001),the number of lumbar vertebrae with a stenosis score≥1(2.47±0.84 vs 1.86±0.95,P=0.004),and the prevalence of redundant nerve roots(14/18 vs 6/13,P=0.017).The AUC of the total lumbar stenosis score was 0.864(P＜0.001,95％CI 0.779-0.950),with an optimal threshold of 3.5(sensitivity:81.3％;specificity:75.7％).The AUC of the number of lumbar vertebrae with a stenosis score ≥1 was 0.691(P=0.007;95％CI 0.565-0.817),with an optimal threshold of 1.5(sensitivity:87.5％;specificity:56.8％).Multivariate logistic regression showed that the number of lumbar spinal stenosis＞1.5(OR=1.493;95％CI 0.392-5.686;P=0.557)and presence of redundant nerve roots(OR=2.815;95％CI 0.740-10.711;P=0.129)had no significant relationship with improvement of lumbar symptoms.The total lumbar stenosis score＞3.5 was significantly related with improvement of lumbar symptoms(OR=10.983;95％CI 3.261-36.994;P＜0.001),which was an independent risk factor for non-improvement in lumbar symtoms after initial cervical decompression in TSS patients.Conclusions:When the total score of lumbar spinal stenosis exceeds 3.5 in TSS patients,the possibility of improvement in lumbar symptoms after initial cervical decompression is small.

Objectives:To investigate the relationship between the improvement of lumbar symptoms and imaging parameters in patients with tandem spinal stenosis(TSS)primarily manifesting as cervical spondylotic myelopathy(CSM)after initial cervical decompression surgery,and to explore related imaging predictive factors.Methods:A retrospective analysis was conducted on 69 TSS patients who underwent primary cervical decom-pression surgery,with an average age of 64.3±10.5 years(ranging from 41 to 86 years old)and a follow-up period of 33.8±5.5 months(ranging from 24 to 48 months).Preoperative symptoms and signs,Nurick gait clas-sification,and preoperative and final follow-up Japanese Orthopaedic Association(JOA)scores for both the cer-vical and lumbar spine were recorded and analyzed.The patients were divided into an improvement group(n=37)and a non-improvement group(n=32)based on the improvement conditions of lumbar spine JOA scores at the final follow-up.Imaging parameters were measured including spinal cord compression ratio,cross-sectional area of the dural sac at the narrowest point of the cervical spinal cord,the ratio of the vertebral canal to the vertebral body and the actual spinal canal width from C3 to C7,and the actual width of the vertebral canal from L1 to L5.The conditions of spinal canal stenosis were evaluated according to the grading system of spinal canal stenosis of cervical and lumbar spine proposed by Lee et al,and the number of cervical verte-brae with a stenosis score ≥1,score at the narrowest part of cervical spinal canal,and the total score of cervical stenosis,as well as the number of lumbar vertebrae with a stenosis score ≥1,score at the narrowest part of lumbar spinal canal,and the total score of lumbar stenosis were calculated.Intergroup comparisons were performed using t tests,chi-square tests,and Mann-Whitney U tests.For the statistic data with statisti-cal differences between the two groups,receiver operating characteristic(ROC)curve was used to determine op-timal thresholds for each parameter,and the area under the ROC curve(AUC)and its corresponding 95％ con-fidence interval(CI)were calculated.Multivariate logistic regression analysis was conducted to identify radiolog-ical predictive factors for non-improvement of lumbar symptoms in TSS patients.Results:The non-improvement group was significantly higher than the improvement group in the total score of lumbar stenosis(5.00±1.68 vs 2.68±1.23,P＜0.001),the number of lumbar vertebrae with a stenosis score≥1(2.47±0.84 vs 1.86±0.95,P=0.004),and the prevalence of redundant nerve roots(14/18 vs 6/13,P=0.017).The AUC of the total lumbar stenosis score was 0.864(P＜0.001,95％CI 0.779-0.950),with an optimal threshold of 3.5(sensitivity:81.3％;specificity:75.7％).The AUC of the number of lumbar vertebrae with a stenosis score ≥1 was 0.691(P=0.007;95％CI 0.565-0.817),with an optimal threshold of 1.5(sensitivity:87.5％;specificity:56.8％).Multivariate logistic regression showed that the number of lumbar spinal stenosis＞1.5(OR=1.493;95％CI 0.392-5.686;P=0.557)and presence of redundant nerve roots(OR=2.815;95％CI 0.740-10.711;P=0.129)had no significant relationship with improvement of lumbar symptoms.The total lumbar stenosis score＞3.5 was significantly related with improvement of lumbar symptoms(OR=10.983;95％CI 3.261-36.994;P＜0.001),which was an independent risk factor for non-improvement in lumbar symtoms after initial cervical decompression in TSS patients.Conclusions:When the total score of lumbar spinal stenosis exceeds 3.5 in TSS patients,the possibility of improvement in lumbar symptoms after initial cervical decompression is small.

Objectives:To evaluate the clinical values of cervical vertebral bone quality(CVBQ)score and cervical endplate bone quality(CEBQ)score in predicting the settlement of Zero Profile(Zero-P)cage after an-terior cervical discectomy and fusion(ACDF).Methods:A retrospective analysis was performed on 72 patients who underwent ACDF with Zero-P cage in the Second Affiliated Hospital of Soochow University.General pa-tient information(including sex,age,comorbidity),laboratory parameters(such as blood calcium and blood glu-cose),surgical details(surgical level and cage type),and imaging data(preoperative cervical MRI and anteropos-terior and lateral X-rays within one week and after more than three months)were collected.On the lateral X-rays taken within one week and＞3 months postoperatively,the heights of the upper and lower margins of vertebrae were measured,and the difference between was defined as the cage subsidence distance.Patients with a subsidence distance ≥ 2mm were assigned to the subsidence group,and those with＜2mm subsidence distance were divided to the non-subsidence group.On preoperative cervical sagittal T1-weighted MRI,plac-ing regions of interest(ROIs)in the medullary region of adjacent vertebral bodies,the subchondral bone region of the endplates,and the cerebrospinal fluid(CSF)in the cerebellomedullary cistern.CVBQ and CEBQ values were the ratios of the average signal intensity of the medullary region of the surgical adjacent vertebral bodies(for CVBQ)and the subchondral bone region of the endplates(for CEBQ)to the signal intensity of the cere-brospinal fluid in the cerebellomedullary cistern.A stratified analysis by gender was conducted to further clarify whether the predictive value of bone quality scores for subsidence is influenced by gender factors.The Pearson correlation coefficient was used to assess the relationship of CVBQ and CEBQ with cage subsidence distance.Receiver operating characteristic(ROC)curves were applied to evaluate the diagnostic efficacy of CVBQ and CEBQ for cage subsidence.Univariate logistic regression analysis was performed to screen for po-tential risk factors,after that age and diabetes,which showed statistical significance,along with CVBQ and CEBQ,were incorporated into the multivariate analysis to assess their independent effects.Results:Cage sub-sidence occurred in 14 patients(subsidence rate:19.4％).Compared with the non-subsidence group,the subsi-dence group of patients was older(male:61.4±16.5 years vs 51.1±10.8 years,P=0.049;female:62.6±13.1 years vs 51.2±7.8 years,P=0.005)and had a higher proportion of patients with diabetes(male:42.9％vs 3.4％,P=0.018;female:42.9％vs 6.9％,P=0.040).Both CVBQ and CEBQ were significantly higher in the subsidence group(CVBQ-male:2.75±0.73 vs 2.02±0.53,P=0.004;female:2.84±0.69 vs 2.00±0.40,P=0.005;CEBQ-male:2.82±0.688 vs 2.05±0.56,P=0.004;female:2.94±0.68 vs 2.05±0.42,P=0.002).Pearson correlation analysis re-vealed a moderate positive correlation between both CVBQ(r=0.58,P＜0.001)and CEBQ(r=0.59,P＜0.001)with subsidence distance.ROC curve analysis indicated that both CVBQ(AUC=0.83)and CEBQ(AUC=0.85)had good predictive values for subsidence,with CEBQ showing slightly better predictive performance.Univariate logistic regression analysis identified age,diabetes,CEBQ,and CVBQ as risk factors for subsidence(P＜0.05).Multivariate analysis showed that after adjusting for age and diabetes,both CEBQ(OR=11.466,P=0.004)and CVBQ(OR=8.804,P=0.005)remained independent risk factors for subsidence,while age and diabetes lost in-dependent significance.The strength of association with subsidence was greater in CEBQ than in CVBQ.Conclusions:Patients with higher CVBQ and CEBQ scores are more likely to experience fusion cage subsi-dence,and both CEBQ and CVBQ can be used to predict cage subsidence in patients after single-level ACDF,CEBQ has better predictive ability than CVBQ.

Objectives:To evaluate the clinical values of cervical vertebral bone quality(CVBQ)score and cervical endplate bone quality(CEBQ)score in predicting the settlement of Zero Profile(Zero-P)cage after an-terior cervical discectomy and fusion(ACDF).Methods:A retrospective analysis was performed on 72 patients who underwent ACDF with Zero-P cage in the Second Affiliated Hospital of Soochow University.General pa-tient information(including sex,age,comorbidity),laboratory parameters(such as blood calcium and blood glu-cose),surgical details(surgical level and cage type),and imaging data(preoperative cervical MRI and anteropos-terior and lateral X-rays within one week and after more than three months)were collected.On the lateral X-rays taken within one week and＞3 months postoperatively,the heights of the upper and lower margins of vertebrae were measured,and the difference between was defined as the cage subsidence distance.Patients with a subsidence distance ≥ 2mm were assigned to the subsidence group,and those with＜2mm subsidence distance were divided to the non-subsidence group.On preoperative cervical sagittal T1-weighted MRI,plac-ing regions of interest(ROIs)in the medullary region of adjacent vertebral bodies,the subchondral bone region of the endplates,and the cerebrospinal fluid(CSF)in the cerebellomedullary cistern.CVBQ and CEBQ values were the ratios of the average signal intensity of the medullary region of the surgical adjacent vertebral bodies(for CVBQ)and the subchondral bone region of the endplates(for CEBQ)to the signal intensity of the cere-brospinal fluid in the cerebellomedullary cistern.A stratified analysis by gender was conducted to further clarify whether the predictive value of bone quality scores for subsidence is influenced by gender factors.The Pearson correlation coefficient was used to assess the relationship of CVBQ and CEBQ with cage subsidence distance.Receiver operating characteristic(ROC)curves were applied to evaluate the diagnostic efficacy of CVBQ and CEBQ for cage subsidence.Univariate logistic regression analysis was performed to screen for po-tential risk factors,after that age and diabetes,which showed statistical significance,along with CVBQ and CEBQ,were incorporated into the multivariate analysis to assess their independent effects.Results:Cage sub-sidence occurred in 14 patients(subsidence rate:19.4％).Compared with the non-subsidence group,the subsi-dence group of patients was older(male:61.4±16.5 years vs 51.1±10.8 years,P=0.049;female:62.6±13.1 years vs 51.2±7.8 years,P=0.005)and had a higher proportion of patients with diabetes(male:42.9％vs 3.4％,P=0.018;female:42.9％vs 6.9％,P=0.040).Both CVBQ and CEBQ were significantly higher in the subsidence group(CVBQ-male:2.75±0.73 vs 2.02±0.53,P=0.004;female:2.84±0.69 vs 2.00±0.40,P=0.005;CEBQ-male:2.82±0.688 vs 2.05±0.56,P=0.004;female:2.94±0.68 vs 2.05±0.42,P=0.002).Pearson correlation analysis re-vealed a moderate positive correlation between both CVBQ(r=0.58,P＜0.001)and CEBQ(r=0.59,P＜0.001)with subsidence distance.ROC curve analysis indicated that both CVBQ(AUC=0.83)and CEBQ(AUC=0.85)had good predictive values for subsidence,with CEBQ showing slightly better predictive performance.Univariate logistic regression analysis identified age,diabetes,CEBQ,and CVBQ as risk factors for subsidence(P＜0.05).Multivariate analysis showed that after adjusting for age and diabetes,both CEBQ(OR=11.466,P=0.004)and CVBQ(OR=8.804,P=0.005)remained independent risk factors for subsidence,while age and diabetes lost in-dependent significance.The strength of association with subsidence was greater in CEBQ than in CVBQ.Conclusions:Patients with higher CVBQ and CEBQ scores are more likely to experience fusion cage subsi-dence,and both CEBQ and CVBQ can be used to predict cage subsidence in patients after single-level ACDF,CEBQ has better predictive ability than CVBQ.

Objective To evaluate the value of shear wave elastography(SWE) in the diagnosis of gastroesophageal varices in patients with hepatitis B-related hepatocellular carcinoma(HCC). Methods From October 2016 to May 2017,a total of 325 patients with hepatitis B-related HCC received conventional ultrasonography and SWE examinations in Shanghai Eastern Hepatobiliary Surgery Hospital were selected. The basic clinical data,conventional ultrasonography,SWE examination parameters and gastroscopy results of 192 patients were successfully collected. The training group ( 120 cases) and the validation group (72 cases) were divided from these patients according to the time order of entering the study.The gastroscopy results were used as the gold standard and the training group were analyzed using univariate and multivariate analysis.A new GOV diagnostic model was established and the diagnosis value of which were validated and evaluated in the validation group. Results Among 9 parameters studied,the maximum flow velocity of the portal vein,the thickness of the spleen and the stiffness of the spleen were independent factors affecting GOV in patients with hepatitis B-related HCC with odds ratio of 0.755(95% CI 0.617-0.924),1.375(95%CI 1.171-1.614) and 1.093(95% CI 1.043 -1.145),respectively(all P < 0.01).T he area under ROC curve of GOV diagnostic model that containd these 3 parameters diagnosing GOV in validation group was 0.914 (95% CI,0.832~0.995).The -1.49 was the best cut-off value with sensitivity,specificity,positive predictive value,negative predivtive value and coincidence rate of 79.0%,92.5%,91.3%,81.5% and 85.8%,respectively. Conclusions The GOV diagnostic model established by combining SWE and conventional ultrasonography is of certain value in diagnosis of GOV in patients with hepatitis B-related HCC yet needs further validation.

Humans ; Severe Acute Respiratory Syndrome ; diagnosis ; therapy