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The purpose of this study is to develop an automated method for identifying the menarche status of adolescents based on EOS radiographs. We designed a deep-learning-based algorithm that contains a region of interest detection network and a classification network. The algorithm was trained and tested on a retrospective dataset of 738 adolescent EOS cases using a five-fold cross-validation strategy and was subsequently tested on a clinical validation set of 259 adolescent EOS cases. On the clinical validation set, our algorithm achieved accuracy of 0.942, macro precision of 0.933, macro recall of 0.938, and a macro F1-score of 0.935. The algorithm showed almost perfect performance in distinguishing between males and females, with the main classification errors found in females aged 12 to 14 years. Specifically for females, the algorithm had accuracy of 0.910, sensitivity of 0.943, and specificity of 0.855 in estimating menarche status, with an area under the curve of 0.959. The kappa value of the algorithm, in comparison to the actual situation, was 0.806, indicating strong agreement between the algorithm and the real-world scenario. This method can efficiently analyze EOS radiographs and identify the menarche status of adolescents. It is expected to become a routine clinical tool and provide references for doctors' decisions under specific clinical conditions.

Purpose: With advancements in minimally invasive techniques, oblique lumbar interbody fusion (OLIF) has gained widespread acceptance and is now commonly performed for adult degenerative scoliosis (ADS). The objective of this research paper is to evaluate three-dimensional (3D) intervertebral motions in EOS models before and after surgery and subsequently assess the efficacy of the 3D correction achieved through staged OLIF., Methods: In this retrospective study, 29 consecutive patients diagnosed with ADS were included, with a mean age of 63.6 years, who underwent staged OLIF surgery between 2018 and 2021. Spinopelvic parameters were assessed using EOS images, and 3D models were reconstructed to measure intervertebral motion angles (IMAs) in 70 surgical intervertebral segments, comprising wedge, lordosis, and axial rotation angles. Regression analysis was conducted to compare IMAs in different planes before and after the staged OLIF surgery., Results: Significant three-dimensional correction was observed in 70 intervertebral segments following the first-stage OLIF. The wedge angles decreased from 5.2°± 4.2° to 2.7°± 2.4° ( P  < 0.001). The lordosis angles increased from 5.1°± 5.9° to 7.8°± 4.6° ( P  = 0.014), while the axial rotation angles decreased from 3.8°± 2.6° to 2.3°± 2.1° ( P  < 0.001). Linear regression analysis revealed a positive correlation between wedge angles and axial angles preoperatively ( P  < 0.001, r  = 0.43), as well as between corrected wedge angles and corrected axial angles ( P  < 0.001, r  = 0.42)., Conclusion: This study demonstrated that intervertebral motions had a correlation between coronal and axial planes in lumbar degenerative scoliosis. First-stage OLIF was efficient at correcting segmental scoliosis by inserting cages while correcting rotation deformity simultaneously, as well as improving the sagittal spinopelvic parameters., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Xu, Ge, Li, Cai, Wu and Sun.)

Objective: This study aimed to compare the clinical outcomes between oblique (OLIF) and transforaminal lumbar interbody fusion (TLIF) for patients with degenerative spondylolisthesis during a 2-year follow-up., Methods: Patients with symptomatic degenerative spondylolisthesis who underwent OLIF (OLIF group) or TLIF (TLIF group) were prospectively enrolled in the authors' hospital and followed up for 2 years. The primary outcomes were treatment effects [changes in visual analog score (VAS) and Oswestry disability index (ODI) from baseline] at 2 years after surgery; these were compared between two groups. Patient characteristics, radiographic parameters, fusion status, and complication rates were also compared., Results: In total, 45 patients were eligible for the OLIF group and 47 patients for the TLIF group. The rates of follow-up were 89% and 87% at 2 years, respectively. The comparisons of primary outcomes demonstrated no different changes in VAS-leg (OLIF, 3.4 vs. TLIF, 2.7), VAS-back (OLIF, 2.5 vs. TLIF, 2.1), and ODI (OLIF, 26.8 vs. TLIF, 30). The fusion rates were 86.1% in the TLIF group and 92.5% in the OLIF group at 2 years ( P  = 0.365). The OLIF group had less estimated blood loss (median, 200 ml) than the TLIF group (median, 300 ml) ( P  < 0.001). Greater restoration of disc height was obtained by OLIF (mean, 4.6 mm) than the TLIF group (mean, 1.3 mm) in the early postoperative period ( P  < 0.001). The subsidence rate was lower in the OLIF group than that in the TLIF group (17.5% vs. 38.9%, P  = 0.037). The rates of total problematic complications were not different between the two groups (OLIF, 14.6% vs. TLIF, 26.2%, P  = 0.192)., Conclusion: OLIF did not show better clinical outcomes than TLIF for degenerative spondylolisthesis, except for lesser blood loss, greater disc height restoration, and lower subsidence rate., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Wu, Ao, Xu, Li, Ge, Wang, Tao, Tian and Sun.)

Background: Intraoperative end plate injury can result in late-onset cage subsidence in oblique lumbar interbody fusion (OLIF). This study aimed to identify risk factors for intraoperative end plate injury and investigate whether a pear-shaped disk correlated with intraoperative end plate injury in OLIF., Methods: We retrospectively reviewed 102 levels in 82 patients (mean age 60.1 ± 10.0 years) who underwent OLIF for degenerative lumbar diseases. Intraoperative end plate injury was evaluated using midline sagittal computed tomography views at 3 days postoperatively and defined as cage breaching into an adjacent cortical end plate >2 mm. Patient demographics, surgical parameters, radiographic parameters, and cage-related parameters were recorded in all surgical levels. Evaluation of risk factors associated with intraoperative end plate injury was performed. Patient-reported outcome, fusion status, and late-onset cage subsidence were analyzed at a minimum of 1 year after the surgery., Results: Intraoperative end plate injury was observed in 26 levels (25.5%). Multivariate logistic regression analysis identified that bone mineral density (odds ratio [OR] = 0.978), preoperative segmental lordosis (OR = 0.790), and pear-shaped disk were risk factors (OR = 5.837) for intraoperative end plate injury. Intraoperative end plate injury occurred in 45.5% of levels with a pear-shaped disk compared with 16.0% of levels with no pear-shaped disk (P < 0.01). Late-onset cage subsidence was significantly more frequent in the injury group than the no-injury group. Patient-reported outcome and fusion status were unrelated to intraoperative end plate injury., Conclusions: A pear-shaped disk is the greatest risk factor for intraoperative end plate injury following OLIF., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To explore the characteristics of vertebral CT Hounsfield units (HU) in elderly patients with acute vertebral fragility fractures., Methods: A total of 299 patients aged ≥ 65 years with acute vertebral fragility fractures were retrospectively reviewed, and 77 patients of them were age- and sex-matched with 77 control patients without any fractures. The vertebral HU value of L1(L1-HU) was measured, and T12 and L2 were used as alternatives for L1 in the case of L1 fracture., Results: There were 460 thoracic and lumbar vertebral fractures in the 299 elderly patients, including 349 acute vertebral fragility fractures and 111 chronic fractures. The average L1-HU value was 66.0 ± 30.6 HU and showed significant difference among patients having different numbers of vertebral fractures (one fracture: 73.3 ± 27.0 HU, two fractures: 58.7 ± 32.5 HU, three or more fractures: 40.7 ± 28.8 HU; P < 0.001). As for the 1:1 age- and sex-matched patients, the L1-HU of the 77 patients with fractures was lower than that of the control patients (70.6 ± 23.4 HU vs. 101.5 ± 36.2 HU, P < 0.001). The area under the receiver operating characteristic curve of using L1-HU to differentiate patients with fractures from controls was 0.77(95% CI 0.70-0.85, P < 0.001). The cutoff value had high specificity of 90% or high sensitivity of 90% to identify patients with fractures of 60 HU and 100 HU, respectively., Conclusions: The elderly patients with acute vertebral fragility fractures have much lower HU values than those without fractures. Moreover, the lower the vertebral HU value is, the more likely the patients have more than one vertebral fracture. These slides can be retrieved under Electronic Supplementary Material.