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Article: Predictability of the fulcrum bending radiograph in scoliosis correction with alternate-level pedicle screw fixation

TitlePredictability of the fulcrum bending radiograph in scoliosis correction with alternate-level pedicle screw fixation
Authors
KeywordsAdolescent
Clinical article
Controlled study
Fulcrum bending radiography
Issue Date2010
PublisherJournal of Bone and Joint Surgery. The Journal's web site is located at http://www.jbjs.org
Citation
Journal Of Bone And Joint Surgery - Series A, 2010, v. 92 n. 1, p. 169-176 How to Cite?
AbstractBackground: The fulcrum bending radiograph accurately predicts scoliosis curve correction in patients with thoracic adolescent idiopathic scoliosis who are managed with hooks. We assessed the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation of the scoliotic spine. Methods: A prospective radiographic analysis of patients with thoracic adolescent idiopathic scoliosis who were managed operatively with alternate-level pedicle screw fixation at a single institution was performed. The Cobb angle was measured on posteroanterior standing coronal radiographs that were made preoperatively and one week postoperatively. The fulcrum flexibility percentage and the fulcrum bending correction index percentage were calculated. Results: Forty-two patients were assessed. The mean age at the time of surgery was 14.6 years, and the mean number of fused levels was 9.4. On the preoperative radiographs, the mean values for the standing Cobb angle, the fulcrum bending radiograph Cobb angle, and fulcrum flexibility were 57.9°, 21.8°, and 62.7%, respectively. On the one-week postoperative radiographs, the mean Cobb angle was 15.4°, the mean curve correction was 73.4%, and the mean fulcrum bending correction index was 122.1%. A significant, positive correlation was noted between the fulcrum bending radiograph angle and the fulcrum bending correction index, indicating that the fulcrum bending radiograph could predict the correction of flexible curves; however, for stiff curves, pedicle screws could provide more correction than the fulcrum bending radiograph predicted. Conclusions: To our knowledge, this is the first study to demonstrate the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation in patients with adolescent idiopathic scoliosis. Curve flexibility may dictate the degree of the fulcrum bending correction index, whereby a curve that is less flexible may achieve a greater fulcrum bending correction index. The fulcrum bending radiograph has potential predictive utility. In addition, pedicle screw constructs appear to have a better ability to correct scoliosis in comparison with hooks and hybrid constructs. Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence. Copyright © 2010 by The Journal of Bone and Joint Surgery, Incorporated.
Persistent Identifierhttp://hdl.handle.net/10722/125166
ISSN
2015 Impact Factor: 5.163
2015 SCImago Journal Rankings: 2.938
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheung, KMCen_HK
dc.contributor.authorNatarajan, Den_HK
dc.contributor.authorSamartzis, Den_HK
dc.contributor.authorWong, YWen_HK
dc.contributor.authorCheung, WYen_HK
dc.contributor.authorLuk, KDKen_HK
dc.date.accessioned2010-10-31T11:15:12Z-
dc.date.available2010-10-31T11:15:12Z-
dc.date.issued2010en_HK
dc.identifier.citationJournal Of Bone And Joint Surgery - Series A, 2010, v. 92 n. 1, p. 169-176en_HK
dc.identifier.issn0021-9355en_HK
dc.identifier.urihttp://hdl.handle.net/10722/125166-
dc.description.abstractBackground: The fulcrum bending radiograph accurately predicts scoliosis curve correction in patients with thoracic adolescent idiopathic scoliosis who are managed with hooks. We assessed the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation of the scoliotic spine. Methods: A prospective radiographic analysis of patients with thoracic adolescent idiopathic scoliosis who were managed operatively with alternate-level pedicle screw fixation at a single institution was performed. The Cobb angle was measured on posteroanterior standing coronal radiographs that were made preoperatively and one week postoperatively. The fulcrum flexibility percentage and the fulcrum bending correction index percentage were calculated. Results: Forty-two patients were assessed. The mean age at the time of surgery was 14.6 years, and the mean number of fused levels was 9.4. On the preoperative radiographs, the mean values for the standing Cobb angle, the fulcrum bending radiograph Cobb angle, and fulcrum flexibility were 57.9°, 21.8°, and 62.7%, respectively. On the one-week postoperative radiographs, the mean Cobb angle was 15.4°, the mean curve correction was 73.4%, and the mean fulcrum bending correction index was 122.1%. A significant, positive correlation was noted between the fulcrum bending radiograph angle and the fulcrum bending correction index, indicating that the fulcrum bending radiograph could predict the correction of flexible curves; however, for stiff curves, pedicle screws could provide more correction than the fulcrum bending radiograph predicted. Conclusions: To our knowledge, this is the first study to demonstrate the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation in patients with adolescent idiopathic scoliosis. Curve flexibility may dictate the degree of the fulcrum bending correction index, whereby a curve that is less flexible may achieve a greater fulcrum bending correction index. The fulcrum bending radiograph has potential predictive utility. In addition, pedicle screw constructs appear to have a better ability to correct scoliosis in comparison with hooks and hybrid constructs. Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence. Copyright © 2010 by The Journal of Bone and Joint Surgery, Incorporated.en_HK
dc.languageengen_HK
dc.publisherJournal of Bone and Joint Surgery. The Journal's web site is located at http://www.jbjs.orgen_HK
dc.relation.ispartofJournal of Bone and Joint Surgery - Series Aen_HK
dc.subjectAdolescent-
dc.subjectClinical article-
dc.subjectControlled study-
dc.subjectFulcrum bending radiography-
dc.titlePredictability of the fulcrum bending radiograph in scoliosis correction with alternate-level pedicle screw fixationen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0021-9355&volume=92&issue=1&spage=169&epage=176&date=2010&atitle=Predictability+of+the+fulcrum+bending+radiograph+in+scoliosis+correction+with+alternate+level+pedicle+screw+fixation-
dc.identifier.emailCheung, KMC:cheungmc@hku.hken_HK
dc.identifier.emailSamartzis, D:dspine@hku.hken_HK
dc.identifier.emailLuk, KDK:hcm21000@hku.hken_HK
dc.identifier.authorityCheung, KMC=rp00387en_HK
dc.identifier.authoritySamartzis, D=rp01430en_HK
dc.identifier.authorityLuk, KDK=rp00333en_HK
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.2106/JBJS.H.01831en_HK
dc.identifier.pmid20048109-
dc.identifier.scopuseid_2-s2.0-73949154134en_HK
dc.identifier.hkuros180202en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-73949154134&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume92en_HK
dc.identifier.issue1en_HK
dc.identifier.spage169en_HK
dc.identifier.epage176en_HK
dc.identifier.isiWOS:000273363600021-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridCheung, KMC=7402406754en_HK
dc.identifier.scopusauthoridNatarajan, D=35334874800en_HK
dc.identifier.scopusauthoridSamartzis, D=34572771100en_HK
dc.identifier.scopusauthoridWong, YW=34882411200en_HK
dc.identifier.scopusauthoridCheung, WY=24504264600en_HK
dc.identifier.scopusauthoridLuk, KDK=7201921573en_HK

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