• Spine · Oct 2015

    Prediction of curve correction using alternate level pedicle screw placement in Adolescent Idiopathic Scoliosis (AIS) Lenke 1 and 2 patients using Supine Side Bending (SB) and Fulcrum Bending (FB) radiograph: The influence of curve magnitude and Lenke AR curves.

    • Mun Keong Kwan, Hassan E Zeyada, and Chan Chris Yin Wei CY.
    • *Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; and†Faculty of Medicine, Alneelain University, Khartoum, Sudan.
    • Spine. 2015 Oct 15; 40 (20): 1605-12.

    Study DesignProspective cohort study.ObjectiveTo compare side bending (SB) and fulcrum bending (FB) radiographs in patients with adolescent idiopathic scoliosis (AIS) and effect of magnitude and AR curves on curve correctability.Summary Of Background DataThe prediction of correction using side bending flexibility (SBF) and fulcrum bending flexibility (FBF) in alternate level pedicle screw (PS) configuration and effect of curve magnitude and AR curves are not well understood.Methods100 AIS Lenke 1 and 2 were recruited. Curve magnitude was stratified to G1 (41°-60°), G2 (61°-80°), G3 (>80°). The main thoracic (MT) curves were subclassified to AR curves [Miyanji F, Pawelek JB, Van Valin SE, et al. Is the lumbar modifier useful in surgical decision making? Defining two distinct Lenke 1A curve patterns. Spine 2008;33:2545-51]. Preoperatively SBF and FBF were determined whereas postoperative parameters were correction rate (CR), fulcrum bending correction index (FBCI), and side bending correction index (SBCI). Correlation test were carried out between SBF, FBF versus CR for the cohort.ResultsThere were 38 (G1), 42 (G2), and 20 (G3) patients. 34% were AR curves. SBF for G1, G2, and G3 were 61.3 ± 14.4, 59.2 ± 16.2 and 43.1 ± 13.1% (P = 0.000) whereas FBF for G1, G2, and G3 were 71.1 ± 16.5, 58.3 ± 18.1 and 52.7 ± 17.1% (P = 0.000). The CR was G1 (74.5 ± 11.5%), G2 (69.2 ± 12.7%), and G3 (70.2 ± 8.6%). FBCI was 1.11 ± 0.3 (G1), 1.28 ± 0.4 (G2) and 1.48 ± 0.6 for G3. SBCI was 1.26 ± 0.2 (G1), 1.50 ± 0.5 (G2), and 1.72 ± 0.4 for G3. There was strong correlation for SBF and FBF versus CR for G1 and G2. For G3, a very strong correlation was established between SBF (r = 0.846, r = 0.716) and FBF versus CR (r = 0.700, r = 0.540). AR curves demonstrated higher SBF and FBF.ConclusionCR remains almost constant in G1, G2, and G3. SBCI and FBCI increase significantly in G1, G2, and G3. Correlation between SBF and FBF and CR was strong for G1, G2, and very strong for G3. AR curves showed better correctability with SB and FB films.

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