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Coronal plane segmental flexibility in thoracic adolescent idiopathic scoliosis assessed by fulcrum-bending radiographs

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Abstract

Knowledge about segmental flexibility in adolescent idiopathic scoliosis is crucial for a better biomechanical understanding, particularly for the development of fusionless, growth-guiding techniques. Currently, there is lack of data in this field. The objective of this study was, therefore, to compute segmental flexibility indices (standing angle minus corrected angle/standing angle). We compared segmental disc angles in 76 preoperative sets of standing and fulcrum-bending radiographs of thoracic curves (paired, two-tailed t tests, p < 0.05). The mean standing Cobb angle was 59.7° (range 41.3°–95°) and the flexibility index of the curve was 48.6% (range 16.6–78.8%). The disc angles showed symmetric periapical distribution with significant decrease (all p values <0.0001) for every cephalad (+) and caudad (−) level change. The periapical levels +1 and −1 wedged at 8.3° and 8.7° (range 3.5°–14.8°), respectively. All angles were significantly smaller on the-bending views (p values <0.0001). We noted mean periapical flexibility indices of 46% (+1), 49% (−1), 57% (+2) and 81% (−2), which were significantly less (p < 0.001) than for the group of remote levels 105% (+3), 149% (−3), 231% (+4) and 300% (−4). The discal and bony wedging was 60 and 40%, respectively, and mean values 35° and 24° (p < 0.0001). Their relationship with the Cobb angle showed a moderate correlation (r = 0.56 and 0.45). Functional, radiographic analysis of idiopathic thoracic scoliosis revealed significant, homogenous segmental tethering confined to four periapical levels. Future research will aim at in vivo segmental measurements in three planes under defined load to provide in-depth data for novel therapeutic strategies.

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Conflict of interest statement

No funds were received in support of this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Orthopaedic Departments, University Children’s Hospital, Roemergasse 8, 4005, Basel, Switzerland

    Carol-Claudius Hasler & Fritz Hefti

  2. Medical Faculty, Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland

    Philippe Büchler

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  1. Carol-Claudius Hasler
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  2. Fritz Hefti
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Correspondence to Carol-Claudius Hasler.

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Hasler, CC., Hefti, F. & Büchler, P. Coronal plane segmental flexibility in thoracic adolescent idiopathic scoliosis assessed by fulcrum-bending radiographs. Eur Spine J 19, 732–738 (2010). https://doi.org/10.1007/s00586-010-1320-2

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