The radiographic assessment of spinal flexibility in scoliosis: a study of the efficacy of the prone push film

Abstract

The use of a "prone push" posteroanterior radiograph of the spine was reviewed in 58 patients with scoliosis (82 curves) who underwent Harrington instrumentation and spinal fusion. The technique is previously undescribed and is accomplished by applying manual pressure to the apices of each curve with the patient prone on the X-ray table. The average correction obtained for all 82 curves was 21.1 degrees, as measured on the push films and 21.8 degrees postoperatively. The difference between these values was not statistically significant. The close relationship between push film and immediate postoperative correction was not altered by the location of the curve, the sex or age of the patient, the presence of a single- or double-major curve pattern, the type of instrumentation employed, nor the etiology of the scoliosis. This method is an alternative to the commonly employed supine lateral bending radiographs. An estimate of spinal flexibility is important for determination of structural change in the spine, the rigidity of curves considered for instrumentation, the curves requiring fusion, the length of fusion necessary, and the amount of correction that is safely possible.