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Pre-operative prone radiographs can reliably determine spinal curve flexibility in adolescent idiopathic scoliosis (AIS)

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Abstract

Purpose

The purpose of this study was to evaluate the correlation between non-effort prone and bending radiographs in determining curve flexibility in adolescent idiopathic scoliosis (AIS).

Methods

A retrospective review of AIS patients who underwent pre-operative full spine radiographic imaging from 2006 to 2019 was performed. The Cobb angle (CA) of proximal thoracic (PT), main thoracic (MT) and thoracolumbar/lumbar (TL/L) curves were measured and correlated on standing, prone and bending radiographs. Standing, bending, and prone measurements were correlated using Spearman’s analysis, and intra-rater reliability was evaluated using intraclass correlation analysis.

Results

A total of 381 patients (74% female) with a mean age of 15.1 ± 2.5 years were identified. A strong correlation existed between the prone and bending CA for the PT (rs = 0.797, p < 0.01) and MT (rs = 0.779, p < 0.01) curve and a moderate correlation existed between the prone and bending TL/L curve (rs = 0.641, p < 0.01). For a non-structural PT curve, a prone CA < 25° correctly identified a bending CA < 25° 96.7% of the time (p < 0.005). For a non-structural MT curve, a prone CA < 35° correctly identified a bending CA < 25° 90.2% of the time (p < 0.005). For a non-structural TL/L curve, a prone CA < 35° correctly identified a bending CA < 25° 95% of the time (p < 0.005).

Conclusion

Prone radiographs demonstrated a moderate to strong correlation with bending radiographs and may be used as a proxy for determining spinal flexibility, especially when bending films are deemed unreliable.

Level of evidence

III.

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Funding

No funds, grants, or other support was received.

Author information

Authors and Affiliations

  1. Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Children’s Hospital at Montefiore Medical Center, 3400 Bainbridge Ave, 6th floor, Bronx, NY, 10467, USA

    Tej Joshi, Soroush Baghdadi, Jaime A. Gomez, Regina Hanstein, Leila Mehraban Alvandi & Jacob F. Schulz

  2. Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, 10467, USA

    Daniel C. Berman

  3. Albert Einstein College of Medicine, Bronx, NY, 10461, USA

    Evan Mostafa

Authors
  1. Tej Joshi
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  2. Daniel C. Berman
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  3. Soroush Baghdadi
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  7. Leila Mehraban Alvandi
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Contributions

All the authors whose names appear on the submission. (1) made substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data. (2) drafted the work or revised it critically for important intellectual content. (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Defining the Role of Authors and Contributors: TJ: Data collection, analysis and interpretation of data, drafted the manuscript, approved the version to be published, and agrees to be accountable for all aspects of the work. DCB: Data collection, revised the manuscript, approved the version to be published, and agrees to be accountable for all aspects of the work. SB: Data collection, revised the manuscript, approved the version to be published, and agrees to be accountable for all aspects of the work. EM: Data collection, revised the manuscript, approved the version to be published, and agrees to be accountable for all aspects of the work. JAG: Conception or design of the work, revised the manuscript, approved the version to be published, and agrees to be accountable for all aspects of the work. RH: Data collection, analysis and interpretation of data, drafted the manuscript, approved the version to be published, and agrees to be accountable for all aspects of the work. LMA: Data collection, revised the manuscript, approved the version to be published, and agrees to be accountable for all aspects of the work. JFS: Conception or design of the work, revised the manuscript, approved the version to be published, and agrees to be accountable for all aspects of the work.

Corresponding author

Correspondence to Jacob F. Schulz.

Ethics declarations

Conflict of interest

Tej Joshi, Daniel C Berman, Soroush Baghdadi, Evan Mostafa, Regina Hanstein, and Leila Mehraban Alvandi declare they have no financial interests. The author Jacob F. Schulz has received Orthopediatrics Spine Consultant fee and defense expert in medical malpractice fee at Local law firm. The author Jaime A Gomez has received speaker honorarium payment from Company Stryker Spine and Company Zimmer Biomet.

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Institutional review board approval was obtained.

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Informed consent to participate in the study was obtained from the participants or their parent or legal guardian in the case of children under 18.

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Joshi, T., Berman, D.C., Baghdadi, S. et al. Pre-operative prone radiographs can reliably determine spinal curve flexibility in adolescent idiopathic scoliosis (AIS). Spine Deform 10, 1063–1070 (2022). https://doi.org/10.1007/s43390-022-00517-5

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  • DOI: https://doi.org/10.1007/s43390-022-00517-5

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