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Background Physiological noise reduction plays a critical role in spinal cord (SC) resting-state fMRI (rsfMRI). Purpose To reduce physiological noise and increase the robustness of SC rsfMRI by using an independent component analysis (ICA)-based nuisance regression (ICANR) method. Study type Retrospective. Subjects Ten healthy subjects (female/male = 4/6, age = 27 ± 3 years, range 24-34 years). Field strength/sequence 3T/gradient-echo echo planar imaging (EPI). Assessment We used three alternative methods (no regression [Nil], conventional region of interest [ROI]-based noise reduction method without ICA [ROI-based], and correction of structured noise using spatial independent component analysis [CORSICA]) to compare with the performance of ICANR. Reduction of the influence of physiological noise on the SC and the reproducibility of rsfMRI analysis after noise reduction were examined. The correlation coefficient (CC) was calculated to assess the influence of physiological noise. Reproducibility was calculated by intraclass correlation (ICC). Statistical tests Results from different methods were compared by one-way analysis of variance (ANOVA) with post-hoc analysis. Results No significant difference in cerebrospinal fluid (CSF) pulsation influence or tissue motion influence were found (P = 0.223 in CSF, P = 0.2461 in tissue motion) in the ROI-based (CSF: 0.122 ± 0.020; tissue motion: 0.112 ± 0.015), and Nil (CSF: 0.134 ± 0.026; tissue motion: 0.124 ± 0.019). CORSICA showed a significantly stronger influence of CSF pulsation and tissue motion (CSF: 0.166 ± 0.045, P = 0.048; tissue motion: 0.160 ± 0.032, P = 0.048) than Nil. ICANR showed a significantly weaker influence of CSF pulsation and tissue motion (CSF: 0.076 ± 0.007, P = 0.0003; tissue motion: 0.081 ± 0.014, P = 0.0182) than Nil. The ICC values in the Nil, ROI-based, CORSICA, and ICANR were 0.669, 0.645, 0.561, and 0.766, respectively. Data conclusion ICANR more effectively reduced physiological noise from both tissue motion and CSF pulsation than three alternative methods. ICANR increases the robustness of SC rsfMRI in comparison with the other three methods. Level of evidence 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:1421-1431.

Physiological noise reduction plays a critical role in spinal cord (SC) resting-state fMRI (rsfMRI).To reduce physiological noise and increase the robustness of SC rsfMRI by using an independent component analysis (ICA)-based nuisance regression (ICANR) method.Retrospective.Ten healthy subjects (female/male = 4/6, age = 27 ± 3 years, range 24-34 years).3T/gradient-echo echo planar imaging (EPI).We used three alternative methods (no regression [Nil], conventional region of interest [ROI]-based noise reduction method without ICA [ROI-based], and correction of structured noise using spatial independent component analysis [CORSICA]) to compare with the performance of ICANR. Reduction of the influence of physiological noise on the SC and the reproducibility of rsfMRI analysis after noise reduction were examined. The correlation coefficient (CC) was calculated to assess the influence of physiological noise. Reproducibility was calculated by intraclass correlation (ICC).Results from different methods were compared by one-way analysis of variance (ANOVA) with post-hoc analysis.No significant difference in cerebrospinal fluid (CSF) pulsation influence or tissue motion influence were found (P = 0.223 in CSF, P = 0.2461 in tissue motion) in the ROI-based (CSF: 0.122 ± 0.020; tissue motion: 0.112 ± 0.015), and Nil (CSF: 0.134 ± 0.026; tissue motion: 0.124 ± 0.019). CORSICA showed a significantly stronger influence of CSF pulsation and tissue motion (CSF: 0.166 ± 0.045, P = 0.048; tissue motion: 0.160 ± 0.032, P = 0.048) than Nil. ICANR showed a significantly weaker influence of CSF pulsation and tissue motion (CSF: 0.076 ± 0.007, P = 0.0003; tissue motion: 0.081 ± 0.014, P = 0.0182) than Nil. The ICC values in the Nil, ROI-based, CORSICA, and ICANR were 0.669, 0.645, 0.561, and 0.766, respectively.ICANR more effectively reduced physiological noise from both tissue motion and CSF pulsation than three alternative methods. ICANR increases the robustness of SC rsfMRI in comparison with the other three methods.2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:1421-1431.

Background: The fulcrum bending radiograph accurately predicts scoliosis curve correction in patients with thoracic adolescent idiopathic scoliosis who are managed with hooks. We assessed the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation of the scoliotic spine. Methods: A prospective radiographic analysis of patients with thoracic adolescent idiopathic scoliosis who were managed operatively with alternate-level pedicle screw fixation at a single institution was performed. The Cobb angle was measured on posteroanterior standing coronal radiographs that were made preoperatively and one week postoperatively. The fulcrum flexibility percentage and the fulcrum bending correction index percentage were calculated. Results: Forty-two patients were assessed. The mean age at the time of surgery was 14.6 years, and the mean number of fused levels was 9.4. On the preoperative radiographs, the mean values for the standing Cobb angle, the fulcrum bending radiograph Cobb angle, and fulcrum flexibility were 57.9°, 21.8°, and 62.7%, respectively. On the one-week postoperative radiographs, the mean Cobb angle was 15.4°, the mean curve correction was 73.4%, and the mean fulcrum bending correction index was 122.1%. A significant, positive correlation was noted between the fulcrum bending radiograph angle and the fulcrum bending correction index, indicating that the fulcrum bending radiograph could predict the correction of flexible curves; however, for stiff curves, pedicle screws could provide more correction than the fulcrum bending radiograph predicted. Conclusions: To our knowledge, this is the first study to demonstrate the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation in patients with adolescent idiopathic scoliosis. Curve flexibility may dictate the degree of the fulcrum bending correction index, whereby a curve that is less flexible may achieve a greater fulcrum bending correction index. The fulcrum bending radiograph has potential predictive utility. In addition, pedicle screw constructs appear to have a better ability to correct scoliosis in comparison with hooks and hybrid constructs. Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

Cervical spondylotic myelopathy (CSM) is a common spinal cord dysfunction disease with complex symptoms in clinical presentation. Resting state fMRI (rsfMRI) has been introduced to study the mechanism of neural development of CSM. However, most of those studies focused on intrinsic functional connectivity rather than intrinsic regional neural activity level which is also frequently analyzed in rsfMRI studies. Thus, this study aims to explore whether the level of neural activity changes on the myelopathic cervical cord and evaluate the possible relationship between this change and clinical symptoms through amplitude of low frequency fluctuation (ALFF). Eighteen CSM patients and twenty five healthy subjects participated in rsfMRI scanning. ALFF was investigated on each patient and subject. The results suggested that ALFF values were higher in the CSM patients at all cervical segments, compared to the healthy controls. The severity of myelopathy was associated with the increase of ALFF. This finding would enrich our understanding on the neural development mechanism of CSM.

Study design A retrospective radiographic study on the type of surgically treated idiopathic scoliosis, with a prospective study on the reliability of the type-related fusion guide. Objectives To identify and classify surgically treated idiopathic scoliosis, and define its related fusion levels by a new classification system. Summary of background data Some classification methods for idiopathic scoliosis have been suggested. However, poor intraobserver reproducibility and interobserver reliability were experienced in these studies, and were not appropriate for guiding surgical planning. Methods A total of 427 surgically treated idiopathic scoliosis cases were reviewed. Preoperative and postoperative standing anteroposterior, lateral, and preoperative supine side-bending radiograph were analyzed using the Scoliosis Research Society definition of scoliosis and curve apex. The resulting classification was tested for intraobserver reliability and interobserver reliability, and by 6 surgeons. Apical frequencies were determined for each type, and prospective surgical testing of the new type and its related fusion guide was performed. Results Three major types and 13 subtypes were identified, of which the Peking Union Medical College type I accounted for 56.62%, type II 42.16%, and type III 1.22%. The interobserver reliability testing was 85% (kappa coefficient 0.832), while intraobserver reproducibility was 91% (kappa coefficient 0.898). Each type had its corresponding fusion levels. A prospective study of 152 cases was performed according to the classification. All of these cases were followed over 18 months, and no postoperative decompensation was noted. Conclusion The Peking Union Medical College classification of idiopathic scoliosis is one system to combine each type with its corresponding fusion level, and it had much higher interobserver reliability and intraobserver reproducibility than the King system. Further prospectivestudies would help to clarify and expand this system.

Background It has been proposed that in-brace correction is the best guideline for prediction of the results of brace treatment for patients with Adolescent Idiopathic Scoliosis (AIS). However, bracing may be a stressful experience for patients and bracing non-compliance could be psychologically related. The purpose of this study was to assess the correlation between brace compliance, in-brace correction and QoL of patients with AIS. Methods Fifty-five patients with a diagnosis of AIS were recruited. All were female and aged 10 years or above when a brace was prescribed, none had undergone prior treatment, and all had a Risser sign of 0–2 and a Cobb angle of 25-40°. The patients were examined in three consecutive visits with 4 to 6 months between each visit. The Chinese translated Trunk Appearance Perception Scale (TAPS), the Chinese translated Brace Questionnaires (BrQ) and the Chinese translated SRS-22 Questionnaires were used in the study. The in-brace Cobb angle, vertebral rotation and trunk listing were also measured. Patients’ compliance, in-brace correction and patients’ QoL were assessed. To identify the relationship among these three areas, logistic regression model and generalized linear model were used. Result For the compliance measure, a significant difference (p = 0.008) was detected on TAPS mean score difference between Visit 1 and Visit 2 in the least compliant group (0–8 hours) and the most compliant group (17–23 hours). In addition, a significant difference (p = 0.000) was detected on BrQ mean score difference between Visit 2 and Visit 3 in the least compliant group (0–8 hours) and the most compliant group (17–23 hours). For the orthosis effectiveness measure, no significant difference was detected between the three groups of bracing hours (0–8 hours, 9–16 hours, 17–23 hours) on in-brace correction (below 40% and 40% or above). For the QoL measure, no significant difference was detected between the two different in-brace correction groups (below 40% and 40% or above) on QoL as reflected by the TAPS, BrQ and SRS-22r mean scores. Conclusion The results showed a positive relationship between patients’ brace wear compliance and patients’ QoL. Poor compliance would cause a lower QoL., published_or_final_version