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The clinical role of preoperative fulcrum-bending and supine side-bending radiographs on the prediction of curve correction in adolescent idiopathic scoliosis

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Abstract

Purpose

Preoperative curve assessment is important in adolescent idiopathic scoliosis (AIS). Our objective is to clarify the role of side-bending radiographs (SBR) and fulcrum-bending radiographs (FBR) in predicting postoperative Cobb angle in nonstructural and structural curves.

Methods

Twenty-five consecutive patients with AIS who underwent correction surgery were included. The Cobb angles of structural and nonstructural curves were determined. Cobb angles were measured based on pre- and postoperative standing anteroposterior radiographs of the whole spine. The Cobb angles of SBR and FBR were measured preoperatively. The difference between the Cobb angle at each bending and the preoperative Cobb angle was defined as the predicted correction angle, whereas the difference between the preoperative Cobb angle and postoperative Cobb angle was defined as the surgical correction angle. The correction index was calculated by dividing the surgical correction angle by the predicted correction angle. The difference between the predicted correction angle and surgical correction angle was defined as the prediction error. We compared SBR and FBR for both structural and nonstructural curves in these terms.

Results

For both curves, the predicted correction angle of FBR was significantly higher than that of SBR, and the correction index of FBR was significantly lower than that of SBR. Patients with a correction index close to 1 and small prediction error had undergone FBR in the structural curve and SBR in the nonstructural curve.

Conclusion

FBR is predictive of postoperative correction angle of the structural curve, whereas SBR is predictive of postoperative correction angle of the nonstructural curve.

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Abbreviations

AIS:

Adolescent idiopathic scoliosis

FBR:

Fulcrum-bending radiographs

ICC:

Intraclass correlation coefficients

PT:

Proximal thoracic

SBR:

Side-bending radiographs

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Acknowledgements

We thank to Shoji Murai, Yu Ymamoto, and Ayaka Inaba for taking appropriate fulcrum bending and side bending radiographs.

Funding

The authors did not receive support from any organization for the submitted work. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Higashiosaka City Medical Center, 3-4-5, Nishiiwata, Higashiosaka, Osaka, 5788588, Japan

    Keisuke Masuda

  2. Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-Cho Kashihara City, Nara, 6348522, Japan

    Hideki Shigematsu, Sachiko Kawasaki, Yuma Suga, Masaki Ikejiri, Takahiro Mui & Yasuhito Tanaka

  3. Department of Orthopedic Surgery, Otemae Hospital, 1-5-34, Otemae, Osaka-Shi Chuo-Ku, Osaka, 5400008, Japan

    Masato Tanaka

  4. Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho Kashihara City, Nara, 6348522, Japan

    Akinori Okuda & Yusuke Yamamoto

Authors
  1. Keisuke Masuda
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Contributions

KM was a major contributor in writing the manuscript. HS conceived the report and helped to draft the manuscript. MT, AO, SK, YS, YY, MI, and TM collected and organized the patient’s data. HS and YT supervised and wrote the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hideki Shigematsu.

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Conflicts of interest

The authors have no conflicts of interest directly relevant to the content of this article.

Ethics approval and consent to participate

This study was approved by ethics committee of Nara Medical University (approval code: 3258). Informed consent was obtained from all individual participants included in the study.

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Written informed consent was obtained from the patients for publication of this study and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

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Masuda, K., Shigematsu, H., Tanaka, M. et al. The clinical role of preoperative fulcrum-bending and supine side-bending radiographs on the prediction of curve correction in adolescent idiopathic scoliosis. Eur Spine J 32, 1140–1145 (2023). https://doi.org/10.1007/s00586-023-07603-w

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  • DOI: https://doi.org/10.1007/s00586-023-07603-w

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