Prediction of correction of scoliosis with use of the fulcrum bending radiograph

Abstract

We used a new method to assess spinal flexibility in thirty patients who were to be managed operatively for adolescent idiopathic scoliosis. The method involves placing the patient in the lateral decubitus position and bent over a fulcrum (a radiolucent padded cylinder) so that the spine is passively hinged open. For thoracic curves the fulcrum is centered under the rib corresponding to the apex of the curve, and for lumbar curves the fulcrum is placed directly under the apex. The preoperative workup for the thirty patients included an anteroposterior radiograph made with the patient standing, a lateral-bending radiograph made with the patient supine, and the new fulcrum bending radiograph. All patients were treated with posterior spinal arthrodesis with segmental spinal instrumentation. The degree of flexibility obtained with the traditional and new methods was compared with the degree of correction observed on the radiograph made, with the patient standing, one week after the operation. Preoperatively, the mean Cobb angle was 58 degrees on the anteroposterior radiograph made with the patient standing, 31 degrees on the lateral-bending radiograph made with the patient supine, and 24 degrees on the fulcrum bending radiograph. The mean angle was 25 degrees on the anteroposterior radiograph made one week postoperatively, so the mean correction was 57 per cent. The difference between the mean angle on the lateral-bending radiograph and that on the postoperative radiograph was significant (p < 0.001); however, the mean angle measured on the preoperative fulcrum bending radiograph and the postoperative angle were almost identical. We found the fulcrum bending radiograph to be more predictive of the degree of flexibility and correctability than the lateral-bending radiograph in this group of patients who had segmental spinal instrumentation for correction of idiopathic scoliosis.