Objective To explore the value of the apparent diffusion coefficient(ADC)ratio and fractional anisotropy(FA)ratio of magnetic resonance(MR)diffusion tensor imaging(DTI)in evaluating the clinical symptoms,prognosis of cervical spondylotic myelopathy(CSM).Methods Thirty-six healthy subjects and fifty CSM patients were involved and received MRI examination.Regions of interest(ROIs)were selected in the ventral funiculus(VF),lateral funiculi(LF),dorsal funiculus(DF),and central gray matter(GM)for ADC and FA measurements.In the control group,ADC and FA ratios were calculated using the original values at the C3/4,C4/5,C5/6,and C6/7levels to divide the corresponding values at their C1/2levels.In the CSM group,ADC and FA ratios were calculated using the ADC and FA values at the most compressed levels to divide the corresponding values at their C1/2levels.In the control group,the variances of the two ratios were compared between different cervical levels and ages.CSM patients were divided into mild,moderate,and severe group according to the preoperative Japanese Orthopaedic Association(JOA)scoring system,and were divided into well,moderate,and poor group according to the postoperative JOA recovery rates.Correlations between DTI parameters,DTI ratios of the VF,LF,DF,and GM of the CSM patients and the JOA scores,JOA recovery rates were assessed among different clinical symptom subgroups and prognosis subgroups.Results In control group,DTI ratios(ADC ratios and FA ratios)in VF,LF,DF,and GM were significantly different between C3/4,C4/5,C5/6,and C6/7levels(P0.05),but not found between different age subgroups.Correlations between DTI ratios of the VF,LF,DF,and GM and JOA scores,JOA recovery rates were significantly superior than the correlations between DTI parameters and JOA scores,JOA recovery rates(P0.05 or P0.01),with the FA ratio being superior to the ADC ratio.Compared with normal control group,the ADC ratios increased gradually in order and FA ratios decreased gradually in the mild,moderate,and severe injury subgroups(P0.05).Compared with normal control group,the ADC ratios increased gradually in order and FA ratios decreased gradually in the well,moderate,and poor recovery subgroups(P0.05).Conclusion DTI ratios might eliminate the influence of age in evaluating the clinical symptoms and prognosis of CSM.Therefore DTI ratios,compared with DTI parameters,may better evaluate the clinical symptoms,prognosis of CSM.

Objective: To evaluate the reliability and validity of the simplified Chinese version of the Quebec Back Pain Disability Scale (SC-QDS).Study Design and Setting: The QDS was translated and cross-culturally adapted into SC following international guidelines. The SC-QDS was completed by 114 patients with low back pain (LBP) and 65 healthy controls, along with the SC Oswestry Disability Index (SC-ODI) and visual analogue scale (VAS). Psychometric evaluation included homogeneity and reproducibility by internal consistency and test-retest reliability and construct validity by calculating the Pearson's correlation coefficients among QDS, SC-ODI, and VAS. Discriminative validity was determined by student's t-test.Results: SC-QDS scores were well distributed, with no floor or ceiling effects. Internal consistency was excellent (Cronbach alpha 0.976). The items and overall SC-QDS were correlated (r = 0.640-0.898 and P < 0.0001). Intraclass correlation coefficient of test-retest reliability was excellent (0.987, 95% confidence interval: 0.978-0.992). Construct validity was confirmed by high correlation of SC-QDS and SC-ODI (r = 0.901 and P < 0.0001) and VAS (r = 0.770 and P < 0.0001) scores, as was discriminative validity by significantly different SC-QDS scores for patients with LBP and controls (46.3 +/- 19.9 vs. 14.6 +/- 8.5 and P < 0.0001).Conclusions: The SC-QDS has good internal consistency, test-retest reliability, and construct and discriminative validity. The SC-QDS is appropriate for clinical and research uses with Chinese-speaking patients with LBP in mainland China. (C) 2012 Elsevier Inc. All rights reserved.

Study Design. Cross-cultural translation and psychometric testing of the Functional Rating Index (FRI). Objective. To evaluate the reliability and validity of the adapted simplified Chinese FRI (SC-FRI) for patients with low back pain (LBP). Summary of Background Data. The FRI is a reliable and valid instrument to assess the perception of function and pain for patients with LBP. However, there is no culturally adapted, reliable, and validated FRI for use in mainland China. Methods. The translation and cross-cultural adaptation were performed following international guidelines. The SC-FRI was administered to 115 patients with LBP along with the simplified Chinese version of the Oswestry Disability Index, 36-Item Short Form Health Survey, and the visual analogue scale. Psychometric testing included internal consistency, test-test reliability, concurrent criterion validity, and construct validity. Results. A high completion rate of 96% and no floor or ceiling effects were noted for the SC-FRI. The internal consistency was good (i.e., Cronbach &agr; = 0.897 for the overall SC-FRI; range, 0.851–0.890, if an item was deleted). Test-retest reliability was excellent, with an intraclass correlation coefficient of 0.948 (95% confidence interval, 0.917–0.968). Concurrent criterion validity assessment demonstrated that the SC-FRI significantly correlated with the visual analogue scale (r = 0.852, P < 0.0001) and the simplified Chinese version of the Oswestry Disability Index (r = 0.958, P < 0.0001). Construct validity was confirmed by the significant Pearson correlation between the SC-FRI and Physical Functioning (r = −0.802, P < 0.0001), Bodily Pain (r = −0.698, P < 0.0001), Social Functioning (r = −0.573, P < 0.0001), Role-Physical (r = −0.503, P < 0.0001), and General Health (r = −0.502, P < 0.0001) domains of the 36-Item Short Form Health Survey. Conclusion. The SC-FRI showed excellent reliability and validity in the evaluation of pain and the functional health status of Chinese-speaking patients with LBP. It is simple and easy to use and can be recommended in clinical and research practice in mainland China.

Study Design. We designed a novel anterior cervical spine surgery preoperative treatment comprising mechanical trachea/esophagus traction and compared the postoperative outcome regarding dysphagia with nontreated patients. Objective. We investigated whether the newly developed preoperative tracheal/esophageal traction exercise (TTE) treatment has an effect on postoperative dysphagia after anterior cervical spine surgery. Summary of Background Data. Dysphagia is a postoperative complication that occurs after anterior cervical spine surgery, and known treatments are perioperative application of methylprednisolone, monitoring of endotracheal tube cuff pressure, and the use of low-profile plates. Methods. We compared the neck disability index, visual analogue scale scores for arm and neck pain, and Bazaz dysphagia scores, a dysphagia index, of 2 randomized groups, 1 week, 3 weeks, 6 weeks, 3 months, and 6 months after cervical spine surgery. One group received TTE treatment for 3 consecutive days before surgery, whereas the control group did not. Results. In the first week after operation, the Bazaz dysphagia scores for patients with second- to fourth-level fusions in the TTE group were significantly better than that in the control group (P = 0.000 for second- and third-level fusions and P = 0.013 for fourth-level fusion). Also at 3 weeks after surgery, the second- to fourth-level fusion patients in the TTE group had better Bazaz scores than those in the control group (P = 0.000 for second- and third-level fusions and P = 0.004 for fourth-level fusion). There was no significant difference of neck disability index and visual analogue scale scores between the 2 groups. Conclusion. Dysphagia could be reduced in patients with multiple-level fusion after anterior cervical spine surgery by preoperative TTE treatment.