Dr Jason Pui Yin Cheung joined the Department of Orthopaedics and Traumatology as a Clinical Assistant Professor in November 2012 and promoted to Clinical Associate Professor with early tenure in 2018. After obtaining his MBBS degree from The University of Hong Kong in 2007, Dr Cheung received his training in Orthopaedics at Queen Mary Hospital. He completed his membership examination in 2009 and obtained his Masters of Medical Sciences degree from The University of Hong Kong in 2012. He completed his specialist training in 2014. He obtained his Master of Surgery in 2017, Postgraduate Diploma in Molecular and Diagnostic Pathology in 2018, and Doctor of Medicine in 2019. His main research interests are paediatric growth and spinal deformity, developmental lumbar spinal stenosis, management of cervical myelopathy and orthopaedic infections.
The Cobb angle (CA) serves as the principal method for assessing spinal deformity, but manual mea... more The Cobb angle (CA) serves as the principal method for assessing spinal deformity, but manual measurements of the CA are time-consuming and susceptible to inter- and intra-observer variability. While learning-based methods, such as SpineHRNet+, have demonstrated potential in automating CA measurement, their accuracy can be influenced by the severity of spinal deformity, image quality, relative position of rib and vertebrae, etc. Our aim is to create a reliable learning-based approach that provides consistent and highly accurate measurements of the CA from posteroanterior (PA) X-rays, surpassing the state-of-the-art method. To accomplish this, we introduce SpineHRformer, which identifies anatomical landmarks, including the vertices of endplates from the 7th cervical vertebra (C7) to the 5th lumbar vertebra (L5) and the end vertebrae with different output heads, enabling the calculation of CAs. Within our SpineHRformer, a backbone HRNet first extracts multi-scale features from the inp...
Hong Kong (Traditional Chinese) ÂS 2012 EuroQol Group EQ-5Dâ ˘ is a trade mark of the EuroQol Gro... more Hong Kong (Traditional Chinese) ÂS 2012 EuroQol Group EQ-5Dâ ˘ is a trade mark of the EuroQol Group. (DOC 82 kb)
Study Design. Prospective study. Objective. To compare the burden between chronic nonspecific low... more Study Design. Prospective study. Objective. To compare the burden between chronic nonspecific low back pain (LBP) and axial spondyloarthropathy (SpA). Summary of Background Data. Chronic nonspecific LBP and SpA are two debilitating yet different chronic musculoskeletal disorders. To compare their burden, propensity score matching is used to control for potential confounders and match the study subjects. Materials and Methods. Two prospectively collected cohorts of LBP (n=269) and SpA (n=218) patients were studied. Outcomes included current LBP, 36-item Short Form Questionnaire, Oswestry Disability Index, EuroQol 5-dimension 5-level Questionnaire, and EuroQol Visual Analog Scale. With the inherent differences between the two types of patients, propensity score matching was performed for comparing the two groups. Baseline covariates of age, sex, education level, occupation, smoking, and drinking history were selected for the estimation of propensity scores for each subject with the logistic regression model. Significant independent variables for the outcome of current back pain were included in the multivariate logistic regressions. Results. A total of 127 matched pairs were identified, with 254 patients. In the matched cohort, more patients with chronic LBP had current back pain (95.3%) as compared with SpA (71.7%). Patients with SpA were younger (P<0.001), with more males (P<0.001), and better educated (P=0.001). There was less current back pain and higher nonsteroidal anti-inflammatory drug use (P<0.001). Most SpA patients had lower Oswestry Disability Index than LBP patients and with low disease activity. Patients with LBP had worse outcome scores as compared with SpA patients given the same Visual Analog Scale. LBP patients had 8.6 times the odds (95% CI: 3.341–20.671; P<0.001) of experiencing current back pain compared with SpA patients. Conclusions. The disease activity of SpA patients is well controlled. However, patients with chronic LBP have worse pain severity, disability, and health-related quality of life. This has implications on resource utilization and the necessity of advancing LBP understanding and management. Level of Evidence. Type I prognostic study.
This cross-sectional study aims to investigate the relationship between the simplified olecranon,... more This cross-sectional study aims to investigate the relationship between the simplified olecranon, simplified digital, and distal radius and ulna (DRU) classifications, and whether they can aid in more comprehensive maturity assessment together. Left hand and wrist and lateral elbow radiographs from pediatric patients were assessed using the three skeletal maturity indices. The association between maturity indices was investigated using Goodman and Kruskal’s gamma, and by mapping of individual grades based on chronological age. Specific maturity grades, at which peak height velocity (PHV) occurs as previously identified, were based upon to explore how the three systems interact. A total of 114 patients (63.2% girls) were studied. Correlations and associations between the three maturity parameters were significant (all at P < 0.001). Mapping revealed uneven spans and coverage of different periods by each index. Olecranon stage 1 coincided with R3 (for girls), R4 (for boys), U3, and SS1. Olecranon stage 5 occurred as early as R7, U6, and SS4. Upon elbow fusion, the simplified digital (SS5–SS8) and DRU (R8–R11 and U7–U9) classifications can be used for assessment until maturity. The inter-relationship of the simplified hand, wrist, and olecranon methods indicates their combined use. DRU grades can be used in growth periods which are less well covered. Prepubertal and growth acceleration phase of pubertal growth spurt can best be assessed by both the simplified olecranon (stages 1–3) and DRU classifications (R1–R5 and U1–U4). All three indices are required during PHV. For post-PHV, DRU (R8–R11 and U7–U9) and simplified digital method (SS5–SS8) complement each other for assessment until skeletal maturity.
Study Design. Prospective observational study. Objective. To determine the prevalence of isolated... more Study Design. Prospective observational study. Objective. To determine the prevalence of isolated thoracic degeneration on magnetic resonance imaging (MRI), demographic factors and imaging features, as well as the patient-reported quality of life outcomes associated with this condition. Summary of Background Data. Thoracic intervertebral discs are least susceptible to disc degeneration (DD) and may represent a manifestation of “dysgeneration.” These discs may never be hydrated from the beginning and seem hypointense on MRI. Patients and Methods. A population-based MRI study of 2007 volunteers was conducted. Each disc from C2/3 to L5/S1 was measured by Pfirrmann and Schneiderman grading. Disc herniation, Schmorl node (SN), high-intensity zones (HIZ), and Modic changes were studied. DD was defined by Pfirrmann 4 or 5. patient-reported quality of life scores, including a 36-item short-form questionnaire and visual analog scale for low back pain, were recorded. Subjects were divided into “isolated thoracic degeneration” (only thoracic segment) and “tandem thoracic degeneration” (thoracic with other segments). The association between imaging findings and isolated thoracic degeneration was determined using multivariate logistic regression. Results. The mean age of the subjects was 50.0 ± 0.5 and 61.4% were females (n = 1232). Isolated thoracic degeneration was identified in 2.3% of the cohort. Factors associated with isolated thoracic degeneration included lower age, C6/7 HIZ, T8/9 HIZ, and T8/9 SN. Factors associated with tandem thoracic degeneration included L4/5 posterior bulging. The thoracic and lumbar tandem degeneration group demonstrated higher bodily pain, despite a lower visual analog scale, and a higher physical component score of the 36-item short form. Conclusions. Isolated thoracic degeneration demonstrated an earlier age of onset, mostly involving the mid-thoracic region (T5/6–T8/9), and in association with findings such as SN. Subjects with tandem thoracolumbar degeneration had less severe lumbar DD and low back pain as compared with those with isolated lumbar degeneration. This paints the picture of “dysgeneration” occurring in the thoracic and lumbar spine. Level of Evidence. 1.
The Cobb angle (CA) serves as the principal method for assessing spinal deformity, but manual mea... more The Cobb angle (CA) serves as the principal method for assessing spinal deformity, but manual measurements of the CA are time-consuming and susceptible to inter- and intra-observer variability. While learning-based methods, such as SpineHRNet+, have demonstrated potential in automating CA measurement, their accuracy can be influenced by the severity of spinal deformity, image quality, relative position of rib and vertebrae, etc. Our aim is to create a reliable learning-based approach that provides consistent and highly accurate measurements of the CA from posteroanterior (PA) X-rays, surpassing the state-of-the-art method. To accomplish this, we introduce SpineHRformer, which identifies anatomical landmarks, including the vertices of endplates from the 7th cervical vertebra (C7) to the 5th lumbar vertebra (L5) and the end vertebrae with different output heads, enabling the calculation of CAs. Within our SpineHRformer, a backbone HRNet first extracts multi-scale features from the inp...
Hong Kong (Traditional Chinese) ÂS 2012 EuroQol Group EQ-5Dâ ˘ is a trade mark of the EuroQol Gro... more Hong Kong (Traditional Chinese) ÂS 2012 EuroQol Group EQ-5Dâ ˘ is a trade mark of the EuroQol Group. (DOC 82 kb)
Study Design. Prospective study. Objective. To compare the burden between chronic nonspecific low... more Study Design. Prospective study. Objective. To compare the burden between chronic nonspecific low back pain (LBP) and axial spondyloarthropathy (SpA). Summary of Background Data. Chronic nonspecific LBP and SpA are two debilitating yet different chronic musculoskeletal disorders. To compare their burden, propensity score matching is used to control for potential confounders and match the study subjects. Materials and Methods. Two prospectively collected cohorts of LBP (n=269) and SpA (n=218) patients were studied. Outcomes included current LBP, 36-item Short Form Questionnaire, Oswestry Disability Index, EuroQol 5-dimension 5-level Questionnaire, and EuroQol Visual Analog Scale. With the inherent differences between the two types of patients, propensity score matching was performed for comparing the two groups. Baseline covariates of age, sex, education level, occupation, smoking, and drinking history were selected for the estimation of propensity scores for each subject with the logistic regression model. Significant independent variables for the outcome of current back pain were included in the multivariate logistic regressions. Results. A total of 127 matched pairs were identified, with 254 patients. In the matched cohort, more patients with chronic LBP had current back pain (95.3%) as compared with SpA (71.7%). Patients with SpA were younger (P<0.001), with more males (P<0.001), and better educated (P=0.001). There was less current back pain and higher nonsteroidal anti-inflammatory drug use (P<0.001). Most SpA patients had lower Oswestry Disability Index than LBP patients and with low disease activity. Patients with LBP had worse outcome scores as compared with SpA patients given the same Visual Analog Scale. LBP patients had 8.6 times the odds (95% CI: 3.341–20.671; P<0.001) of experiencing current back pain compared with SpA patients. Conclusions. The disease activity of SpA patients is well controlled. However, patients with chronic LBP have worse pain severity, disability, and health-related quality of life. This has implications on resource utilization and the necessity of advancing LBP understanding and management. Level of Evidence. Type I prognostic study.
This cross-sectional study aims to investigate the relationship between the simplified olecranon,... more This cross-sectional study aims to investigate the relationship between the simplified olecranon, simplified digital, and distal radius and ulna (DRU) classifications, and whether they can aid in more comprehensive maturity assessment together. Left hand and wrist and lateral elbow radiographs from pediatric patients were assessed using the three skeletal maturity indices. The association between maturity indices was investigated using Goodman and Kruskal’s gamma, and by mapping of individual grades based on chronological age. Specific maturity grades, at which peak height velocity (PHV) occurs as previously identified, were based upon to explore how the three systems interact. A total of 114 patients (63.2% girls) were studied. Correlations and associations between the three maturity parameters were significant (all at P < 0.001). Mapping revealed uneven spans and coverage of different periods by each index. Olecranon stage 1 coincided with R3 (for girls), R4 (for boys), U3, and SS1. Olecranon stage 5 occurred as early as R7, U6, and SS4. Upon elbow fusion, the simplified digital (SS5–SS8) and DRU (R8–R11 and U7–U9) classifications can be used for assessment until maturity. The inter-relationship of the simplified hand, wrist, and olecranon methods indicates their combined use. DRU grades can be used in growth periods which are less well covered. Prepubertal and growth acceleration phase of pubertal growth spurt can best be assessed by both the simplified olecranon (stages 1–3) and DRU classifications (R1–R5 and U1–U4). All three indices are required during PHV. For post-PHV, DRU (R8–R11 and U7–U9) and simplified digital method (SS5–SS8) complement each other for assessment until skeletal maturity.
Study Design. Prospective observational study. Objective. To determine the prevalence of isolated... more Study Design. Prospective observational study. Objective. To determine the prevalence of isolated thoracic degeneration on magnetic resonance imaging (MRI), demographic factors and imaging features, as well as the patient-reported quality of life outcomes associated with this condition. Summary of Background Data. Thoracic intervertebral discs are least susceptible to disc degeneration (DD) and may represent a manifestation of “dysgeneration.” These discs may never be hydrated from the beginning and seem hypointense on MRI. Patients and Methods. A population-based MRI study of 2007 volunteers was conducted. Each disc from C2/3 to L5/S1 was measured by Pfirrmann and Schneiderman grading. Disc herniation, Schmorl node (SN), high-intensity zones (HIZ), and Modic changes were studied. DD was defined by Pfirrmann 4 or 5. patient-reported quality of life scores, including a 36-item short-form questionnaire and visual analog scale for low back pain, were recorded. Subjects were divided into “isolated thoracic degeneration” (only thoracic segment) and “tandem thoracic degeneration” (thoracic with other segments). The association between imaging findings and isolated thoracic degeneration was determined using multivariate logistic regression. Results. The mean age of the subjects was 50.0 ± 0.5 and 61.4% were females (n = 1232). Isolated thoracic degeneration was identified in 2.3% of the cohort. Factors associated with isolated thoracic degeneration included lower age, C6/7 HIZ, T8/9 HIZ, and T8/9 SN. Factors associated with tandem thoracic degeneration included L4/5 posterior bulging. The thoracic and lumbar tandem degeneration group demonstrated higher bodily pain, despite a lower visual analog scale, and a higher physical component score of the 36-item short form. Conclusions. Isolated thoracic degeneration demonstrated an earlier age of onset, mostly involving the mid-thoracic region (T5/6–T8/9), and in association with findings such as SN. Subjects with tandem thoracolumbar degeneration had less severe lumbar DD and low back pain as compared with those with isolated lumbar degeneration. This paints the picture of “dysgeneration” occurring in the thoracic and lumbar spine. Level of Evidence. 1.
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