• Chen He and Man-Sang Wong.
• Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University.
• Spine. 2017 Jun 9.

Study DesignLiterature review OBJECTIVE.: To review the contemporary methods for spinal flexibility assessment on the patients with adolescent idiopathic scoliosis (AIS).Summary Of Background DataSpinal flexibility is one of the essential parameters for clinical decisions on the patients with AIS. Various methods of spinal flexibility assessment are proposed, but which method(s) could better reveal spinal flexibility or predict treatment effect is unclear.MethodsThe databases of AbleData, IBSS, Academic Search Premier, MEDLINE/PubMed, CINAHL, Recal Legacy, REHABDATA, Embase and Web of Science were searched. The study inclusive criteria were: (1) prospective cohort study; (2) investigated spinal flexibility on AIS patients; (3) published in English 1996-2016.ResultsTotally fifteen articles were included and eleven methods of spinal flexibility assessment were introduced in this review. Traction methods revealed higher spinal flexibility on the patients with severe curves (>65°) but lower spinal flexibility on the patients with moderate curves (40-65°), comparing with lateral bending methods. Among lateral bending methods, fulcrum bending flexibility is higher on thoracic (T) curves whereas supine with lateral bending flexibility is higher on thoracolumbar or lumbar (TL/L) curves. For predicting postoperative correction, fulcrum bending flexibility showed higher correlation with postoperative correction on moderate curves and traction flexibility showed higher correlation on severe curves, comparing with supine with lateral bending method.ConclusionsCurve magnitude and location are two important parameters in selecting appropriate method for spinal flexibility assessment and treatment effect prediction. The traction method should be considered for the patients with severe curves, while the lateral bending method is suggested for the patients with moderate curves. The fulcrum bending method is recommended to assess T curve flexibility whereas the supine with lateral bending method is for the assessment of TL/L curve flexibility. A comprehensive guideline for selecting spinal flexibility assessment method(s) should be established via future studies.Level Of Evidence4.

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