title: Forced lordosis on the thoracolumbar junction can correct coronal plane deformity in adolescents with double major curve pattern idiopathic scoliosis.
abstract: METHODS
  A prospective radiographic study was conducted.
  
  
  OBJECTIVE
  To support our hypothesis that correction of the scoliosis may benefit from a lordotic fulcrum force in the sagittal plane on the thoracolumbar spine.
  
  
  BACKGROUND
  Adolescent idiopathic scoliosis is an important spinal deformity. Correction can be achieved with limited options by current bracing techniques. Lateral bending radiographs are used to assess flexibility and predict treatment outcome. The corrective potential of a lordotic fulcrum force in the sagittal plane has not been addressed.
  
  
  METHODS
  Anterioposterior spine radiographs of patients with a double major curve pattern scoliosis were obtained in 2 groups of patients. In group A radiographs in 3 positions: standing, and supine with and without fulcrum (n = 12), and group B radiographs in 2 positions (n = 28): standing, and supine with lordotic fulcrum. Cobb angles were determined and evaluated statistically. The sagittal contour of the thoracolumbar junction in standing position was measured.
  
  
  RESULTS
  In group A with the patients lying supine a correction of the Cobb angle was obtained at the thoracic level of 15.4% and the lumbar level of 27.5% (P < 0.001). Adding in supine position a lordotic fulcrum on the thoracolumbar junction resulted in a coupled further correction at the thoracic level of 15.7% and lumbar 18.1% (P < 0.001). Comparing in group A the thoracic and lumbar curvatures in standing position with that on a lordotic fulcrum in supine position revealed a total reduction of 31% and 45.6%, respectively. For the independent group B this reduction in 1 step is 38% and 44.4%, respectively.
  
  
  CONCLUSIONS
  Scoliotic deformities are significantly reduced in supine position by a lordotic fulcrum force on the thoracolumbar junction. These findings may have consequences on bracing techniques.
authors: Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands. pvanloon@wxs.nl
authors: Piet J M
authors: PJ
authors: van Loon
authors: Bob A G
authors: BA
authors: Kühbauch
authors: Frederik B
authors: FB
authors: Thunnissen
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D011187:Posture; D011446:Prospective Studies; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging; D016896:Treatment Outcome