title: The value of radiographs obtained during forced traction under general anaesthesia in predicting flexibility in idiopathic scoliosis with Cobb angles exceeding 60 degree.
abstract: Our aim in this prospective radiological study was to determine whether the flexibility rate calculated from radiographs obtained during forced traction under general anaesthesia, was better than that of fulcrum-bending radiographs before corrective surgery in predicting the extent of the available correction in patients with idiopathic scoliosis. We evaluated 33 patients with a Cobb angle > 60 degrees on a standing posteroanterior radiograph, who had been treated by posterior correction. Pre-operative standing fulcrum-bending radiographs and those with forced-traction under general anaesthesia were obtained. Post-operative standing radiographs were taken after surgical correction. The mean forced-traction flexibility rate was 55% (SD 11.3) which was significantly higher than the mean fulcrum-bending flexibility rate of 32% (SD 16.1) (p < 0.001). We found no correlation between either the forced-traction or fulcrum-bending flexibility rates and the correction rate post-operatively (p = 0.24 and p = 0.44, respectively). Radiographs obtained during forced traction under general anaesthesia were better at predicting the flexibility of the curve than fulcrum-bending radiographs in curves with a Cobb angle > 60 degrees in the standing position and may identify those patients for whom supplementary anterior surgery can be avoided.
authors.affiliation: Department of Orthopaedic Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK. ti11@le.ac.uk
authors.forename: T
authors.initials: T
authors.lastname: Ibrahim
authors.forename: O A
authors.initials: OA
authors.lastname: Gabbar
authors.forename: K
authors.initials: K
authors.lastname: El-Abed
authors.forename: M J
authors.initials: MJ
authors.lastname: Hutchinson
authors.forename: I W
authors.initials: IW
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D001175:Arthrography / Q000379:methods*; D053587:Arthrometry, Articular; D002648:Child; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000502:physiology / Q000601:surgery; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D012720:Severity of Illness Index; D013223:Statistics as Topic; D014143:Traction