Evaluating flexibility and predicting curve correction using fulcrum-bending radiographs in Lenke type 2 adolescent idiopathic scoliosis |
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| Affiliation: | 1. Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan;2. Niigata Spine Center, Kameda Daiichi Hospital, Niigata, Japan;3. Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan;1. Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan;2. Information Management Centre, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan;3. Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan;1. Department of Orthopaedic Surgery, Nakagami Hospital, Japan;2. Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Hokushin Hospital, Japan;3. Rehabilitation Clinic Yamaguchi, Japan;4. Department of Orthopaedic Surgery, University of the Ryukyus School of Medicine, Japan;1. Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, Hiroshima, 734-8551, Japan;2. Department of Orthopaedic Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo, Higashi-Hiroshima, Hiroshima, 739-0041, Japan;1. Department of Orthopaedic, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, 054000, China;2. Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China;1. Nara Prefecture General Medical Center, Narshi, Nara, 6308581 Japan;2. Kokuho Chuo Hospital, Shiki-gun, Nara, 6360302 Japan;3. Imperial Gift Saiseikai Nara Hospital, Nara-shi Nara, 6308145 Japan;4. Nara Medical University, School of Medicine, Kashihara-shi, Nara, 6348522 Japan |
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| Abstract: | ![]()
BackgroundFulcrum-bending (FB) correction is considered to provide the best estimation of main thoracic (MT) curve flexibility and postoperative correction in surgical treatment for adolescent idiopathic scoliosis (AIS). However, few studies evaluated the usefulness of FB radiographs for proximal thoracic (PT) curve. We aimed to perform flexibility assessments using both active side-bending (SB) and FB radiographs and evaluate surgical outcomes after posterior spinal fusion (PSF) for Lenke type 2 AIS.MethodsThis study included 38 consecutive patients with Lenke type 2 AIS who underwent PSF using a pedicle screw construct with a minimum 2-year follow-up. Radiographic parameters, including correction rate, SB and FB flexibility, and FB correction index (FBCI: [correction rate/FB flexibility] × 100), were evaluated preoperatively, immediately after surgery, and at the 2-year follow-up. The clinical outcomes were preoperatively evaluated using the Scoliosis Research Outcomes Instrument-22 and at the follow-up.ResultsAll scoliosis curves significantly improved and shoulder balance shifted toward left shoulder elevation (all comparisons, p < 0.0001). There were significant differences between the SB and FB corrections in the PT and MT curves (p < 0.0001). The magnitudes of the discrepancies between the SB and FB corrections in the PT and MT curves were 11.2° ± 5.2° and 11.6° ± 7.2°, respectively. FB correction did not differ from postoperative Cobb angles correction immediately after surgery or at the 2-year follow-up; the mean FBCIs in the PT and MT curves were 98.8% and 105.5%, respectively. The self-image domain SRS-22 scores had significantly increased at the 2-year follow-up (p < 0.0001).ConclusionsThere were significant differences between the SB and FB corrections, and FB correction tended to approximate the postoperative curve correction (FBCI = 100%) for PT and MT curves in patients with Lenke type 2 AIS. FB flexibility is more reliable than SB flexibility in evaluating actual curve flexibility even for the PT curve. |
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