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Article: The predictive value of the fulcrum bending radiograph in spontaneous apical vertebral derotation in adolescent idiopathic scoliosis

TitleThe predictive value of the fulcrum bending radiograph in spontaneous apical vertebral derotation in adolescent idiopathic scoliosis
Authors
KeywordsVertebral Derotation
Idiopathic Scoliosis
Fulcrum Bending Radiograph
Issue Date2012
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
Citation
Spine, 2012, v. 37 n. 15, p. E922-E926 How to Cite?
AbstractSTUDY DESIGN: A prospective cohort study of Cobb angles (CA) and apical vertebral rotations (AVR) in 25 patients who had adolescent idiopathic scoliosis. OBJECTIVE: To assess in vivo the concomitant vertebral derotation occurring with correction of scoliosis deformity as a result of coupling effect by using the fulcrum bending radiograph and to assess whether the fulcrum bending radiograph can predict the amount of postoperative apical derotation when no additional intraoperative apical derotation maneuver is used. SUMMARY OF BACKGROUND DATA: Adolescent idiopathic scoliosis (AIS) is a 3-dimensional coupling deformity. Various studies have reported vertebral derotational effects, using different implant constructs and surgical techniques for AIS. However, none of them have considered the spontaneous coupling effect on vertebral derotation produced by correction of the coronal deformity, in particular, using the predictive capacity of the preoperative fulcrum bending radiograph. METHOD: Twenty-five patients with flexible Lenke type 1 AIS with CA greater than 45 degrees who underwent posterior spinal fusion with instrumentation, without direct apical derotation were prospectively assessed. CA and AVR in standing, supine, and fulcrum bending positions preoperatively and in supine position postoperatively were assessed on radiographs and computed tomographic scans. RESULTS.: The study entailed 80% adolescent girls and 20% adolescent boys (mean age, 15.5 years). The mean AVR values on preoperative standing, supine, and fulcrum bending positions and postoperation were 24.2 degrees , 17.7 degrees , 9.8 degrees , and 8.1 degrees respectively. The preoperative AVR highly correlated with the preoperative CA (R = 0.75). The postoperative AVR was correlated with the postoperative CA (r = 0.82) and the change in curve magnitude (r = -0.49), correction rate (r = -0.83), and fulcrum bending correction index (r = -0.45) (P < 0.05). There was no significant difference in AVR between preoperative fulcrum bending and postoperative assessment. CONCLUSION: Correction of scoliosis deformity produces spontaneous reduction of rotational deformity through coupling. The amount of spontaneous apical vertebral derotation with fulcrum bending can be used to assess the flexibility of the rotational deformity. In flexible curves, it also predicts the amount of apical derotation achievable with surgery. These should be considered when assessing the derotational effect of different implants and surgical strategies.
Persistent Identifierhttp://hdl.handle.net/10722/170207
ISSN
2015 Impact Factor: 2.439
2015 SCImago Journal Rankings: 1.459
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLuk, KDKen_US
dc.contributor.authorCheung, WYen_US
dc.contributor.authorWong, Yen_US
dc.contributor.authorCheung, KMCen_US
dc.contributor.authorWong, YWen_US
dc.contributor.authorSamartzis, Den_US
dc.date.accessioned2012-10-30T06:06:17Z-
dc.date.available2012-10-30T06:06:17Z-
dc.date.issued2012en_US
dc.identifier.citationSpine, 2012, v. 37 n. 15, p. E922-E926en_US
dc.identifier.issn0362-2436en_US
dc.identifier.urihttp://hdl.handle.net/10722/170207-
dc.description.abstractSTUDY DESIGN: A prospective cohort study of Cobb angles (CA) and apical vertebral rotations (AVR) in 25 patients who had adolescent idiopathic scoliosis. OBJECTIVE: To assess in vivo the concomitant vertebral derotation occurring with correction of scoliosis deformity as a result of coupling effect by using the fulcrum bending radiograph and to assess whether the fulcrum bending radiograph can predict the amount of postoperative apical derotation when no additional intraoperative apical derotation maneuver is used. SUMMARY OF BACKGROUND DATA: Adolescent idiopathic scoliosis (AIS) is a 3-dimensional coupling deformity. Various studies have reported vertebral derotational effects, using different implant constructs and surgical techniques for AIS. However, none of them have considered the spontaneous coupling effect on vertebral derotation produced by correction of the coronal deformity, in particular, using the predictive capacity of the preoperative fulcrum bending radiograph. METHOD: Twenty-five patients with flexible Lenke type 1 AIS with CA greater than 45 degrees who underwent posterior spinal fusion with instrumentation, without direct apical derotation were prospectively assessed. CA and AVR in standing, supine, and fulcrum bending positions preoperatively and in supine position postoperatively were assessed on radiographs and computed tomographic scans. RESULTS.: The study entailed 80% adolescent girls and 20% adolescent boys (mean age, 15.5 years). The mean AVR values on preoperative standing, supine, and fulcrum bending positions and postoperation were 24.2 degrees , 17.7 degrees , 9.8 degrees , and 8.1 degrees respectively. The preoperative AVR highly correlated with the preoperative CA (R = 0.75). The postoperative AVR was correlated with the postoperative CA (r = 0.82) and the change in curve magnitude (r = -0.49), correction rate (r = -0.83), and fulcrum bending correction index (r = -0.45) (P < 0.05). There was no significant difference in AVR between preoperative fulcrum bending and postoperative assessment. CONCLUSION: Correction of scoliosis deformity produces spontaneous reduction of rotational deformity through coupling. The amount of spontaneous apical vertebral derotation with fulcrum bending can be used to assess the flexibility of the rotational deformity. In flexible curves, it also predicts the amount of apical derotation achievable with surgery. These should be considered when assessing the derotational effect of different implants and surgical strategies.en_US
dc.languageengen_US
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.comen_US
dc.relation.ispartofSpineen_US
dc.subjectVertebral Derotationen_US
dc.subjectIdiopathic Scoliosisen_US
dc.subjectFulcrum Bending Radiographen_US
dc.subject.meshOutcome Assessment (Health Care)-
dc.subject.meshPredictive Value of Tests-
dc.subject.meshScoliosis - diagnosis - surgery-
dc.subject.meshSpinal Fusion - instrumentation - methods-
dc.subject.meshSpine - radiography - surgery-
dc.titleThe predictive value of the fulcrum bending radiograph in spontaneous apical vertebral derotation in adolescent idiopathic scoliosisen_US
dc.typeArticleen_US
dc.identifier.emailLuk, KDK: hcm21000@hku.hken_US
dc.identifier.emailCheung, WY: lcheung@hkucc.hku.hken_US
dc.identifier.emailCheung, KMC: cheungmc@hku.hken_US
dc.identifier.emailWong, YW: yatwa@hkucc.hku.hk-
dc.identifier.emailSamartzis, D: dspine@hku.hk-
dc.identifier.authorityLuk, KDK=rp00333en_US
dc.identifier.authorityCheung, KMC=rp00387en_US
dc.identifier.authoritySamartzis, D=rp01430en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1097/BRS.0b013e31824f108fen_US
dc.identifier.pmid22744400-
dc.identifier.scopuseid_2-s2.0-84863465023en_US
dc.identifier.hkuros210530-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-84863465023&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume37en_US
dc.identifier.issue15en_US
dc.identifier.spageE922en_US
dc.identifier.epageE926en_US
dc.identifier.isiWOS:000305983800008-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridSamartzis, D=34572771100en_US
dc.identifier.scopusauthoridWong, YW=36247941700en_US
dc.identifier.scopusauthoridCheung, KMC=7402406754en_US
dc.identifier.scopusauthoridWong, Y=55292842900en_US
dc.identifier.scopusauthoridCheung, WY=55188419600en_US
dc.identifier.scopusauthoridLuk, KDK=7201921573en_US

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