A Prospective Comparison of the Coronal Deformity Correction in Thoracic Scoliosis Using Four Different Instrumentations and the Fulcrum-Bending Radiograph

Abstract

Study Design. A prospective study on comparing coronal deformity correction in thoracic scoliosis using four different instrumentations. Objectives. To compare the ability of four different instrumentation systems in correcting thoracic scoliosis based on the curve flexibility as reviewed by the fulcrum-bending radiograph. Summary of Background Data. The fulcrum-bending radiograph has been shown to be able to accurately reflect the flexibility of thoracic curves, and the fulcrum bending correction index (FBCI) predicts the amount of correction achieved by current surgical techniques. By recruiting curves of known flexibility, the efficacy of the different instrumentations in correcting coronal deformity can be truly compared. Methods. A consecutive series of 127 patients with Idiopathic scoliosis were treated by one of four implants: CD-Horizon (CD-H), Moss Miami (MM), TSRH, and ISOLA. All surgeries were performed by the same group of surgeons using the respective recommended techniques. FBCI was used to compare the correction achieved by these implants. Results. The mean FBCI/correction rate was 101.0%/ 57.9% in the TSRH group, 103.5%/58.5% in ISOLA, 109.1%/67.6% in CD-H, and 100.2%/62.7% in the MM group. The correction rate was significantly (P < 0.05) higher in the CD-H group than those in the TSRH and ISOLA groups, while the differences in the FBCI between the four implants were not statistically significant. Conclusions. When curve flexibility is taken into account, despite differences in material and design of four commonly used instrumentations, their ability to correct thoracic scoliosis is the same. Future studies describing surgical correction results should be based on the FBCI.