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Preoperative supine traction radiographs often result in higher Lenke classifications than supine bending radiographs in adolescent idiopathic scoliosis

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Abstract

Study design

Retrospective chart and radiographic review.

Objective

The purpose of this study is to determine if both traction and side-bending radiographs yield the same Lenke classification.

Summary of background date

Supine side-bending radiographs are used to evaluate curve flexibility and assign Lenke classification in Adolescent Idiopathic Scoliosis (AIS). Supine traction radiographs are another tool used by treating surgeons to gauge flexibility and appropriate levels for spinal fusion in AIS.

Methods

Retrospective chart and radiographic review were performed on AIS patients that underwent a posterior spinal fusion from 2008 to 2017. Cobb angles and Lenke classifications were determined on all upright posterioanterior (PA) spine radiographs, supine traction radiographs, and four supine bending radiographs. Statistical analysis using independent t tests and chi-square tests as appropriate were compared between patients with or without discordant Lenke classifications with p value set at < 0.05 for statistical significance.

Results

184 patients met inclusion criteria, 36 males and 148 females. The average Cobb angle for the proximal thoracic (PT) curve was 27.2°, main thoracic (MT) curve was 60.5°, and thoracolumbar/lumbar (TL/L) curve was 48.0°. Significantly less curve correction was found with supine traction radiographs compared with bending radiographs: PT (23.1° vs 18.9°, p < 0.001), MT (38.9° vs 37.9°, p = 0.015), and TL/L (25.9° vs. 18.0°, p < 0.001). Lenke Classification was found concordant in 151/184 (82.1%). Traction views in the discordant Lenke classification group demonstrated less curve correction than those in the concordant group: PT (27.4° vs. 22.1°, p = 0.011), MT (45.3° vs. 37.5°, p < 0.001), and TL/L (29.3° vs 25.1°, p = 0.019).

Conclusion

Supine traction and supine bending radiographs provided a concordant Lenke classification 82.1% of the time. However, supine traction radiographs demonstrate less curve correction, a higher Lenke classification, and underestimated the TL/L curve correction to a greater degree. A single supine traction film is not an adequate substitute to side-bending radiographs when determining Lenke classification in patients with Adolescent Idiopathic Scoliosis.

Level of evidence

III.

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Funding

No funding was received for this work.

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Authors and Affiliations

  1. Marshall Orthopaedic Surgery Resident, 1600 Medical Center Drive, Suite G500, Huntington, WV, 25701, USA

    Sohaib Malik, Thomas Schmicker & Adam Kopiec

  2. Shriners Hospitals for Children Medical Center, University of Kentucky, 110 Conn Terrace Lexington, Lexington, KY, 40508, USA

    Vishwas Talwalkar, Vince Prusick, Ryan Muchow & Henry Iwinski

Authors
  1. Sohaib Malik
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  2. Thomas Schmicker
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  3. Adam Kopiec
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  4. Vishwas Talwalkar
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  5. Vince Prusick
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  6. Ryan Muchow
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  7. Henry Iwinski
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Contributions

SM: Made substantial contributions to analysis and interpretation of data, assisted in drafting the work, approved version to be publish, and agree to be accountable for all aspects of the work. Authorship requirement. TS: Made substantial contributions to the design of the work, assisted in drafting the work, approved version to be publish, and agree to be accountable for all aspects of the work. AK: Made substantial contribution to the acquisition of data, assisted in drafting the work, approved version to be publish, and agree to be accountable for all aspects of the work. VT, VP, RM, HI: Made substantial contribution to the design of the work, revised it critically for important intellectual content, approved version to be publish, and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Sohaib Malik.

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Conflict of interest

The author(s) declare that they have no conflicts of interest.

Ethics approval

This study was approved by the institutional review board at Shriner’s Hospital in Lexington, KY, USA.

Informed consent

Informed consent not needed secondary to retrospective nature of study.

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Malik, S., Schmicker, T., Kopiec, A. et al. Preoperative supine traction radiographs often result in higher Lenke classifications than supine bending radiographs in adolescent idiopathic scoliosis. Spine Deform 9, 1049–1052 (2021). https://doi.org/10.1007/s43390-020-00271-6

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  • DOI: https://doi.org/10.1007/s43390-020-00271-6

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