A PROSPECTIVE COMPARISON BETWEEN PRE-OPERATIVE FULCRUM BENDING VIEWS AND INTRAOPERATIVE TRACTION VIEWS IN PREDICTING POSTERIOR SCOLIOSIS CORRECTION USING PEDICULAR SCREWS.

Abstract

Background: To assess reliability of traction views under GA in predicting curve flexibility when performing posterior correction of scoliosis deformity with pedicular screws.

Methods: Compare reliability of preoperative fulcrum bending film with intraoperative traction films in predicting and influencing the correction of scoliosis deformity using posterior pedicular screws. Twenty patients undergoing corrective surgery for scoliosis deformity the average age was 19 years old. The Lenke classification was used to classify the curves using pre-operative fulcrum bending views, the student’s t test was used to assess the reliability of x-ray views in predicting the end results.

Results: The mean preoperative major structural Cobb angle was 80 degrees and mean minor structural Cobb angle was 27, the mean major structural Cobb angle on fulcrum bending views was 49 degrees, the mean major structural Cobb angle on the traction views was 33.6, the minor structural Cobb angle was 9 degrees thus changing the lenke classification of the curve reducing the numbers of levels for fixation by at least one level either end of the curve. Posterior pedicular screws were used in all the patients. The number of patient at risk of combined anterior release and posterior instrumentation was reduced from 13 to 2. The P value for the difference between fulcrum bending views and traction views was P< 0.0001, for traction and end result P=0.18

Conclusion: The traction views under GA were superior in predicting curve flexibility when performing only posterior scoliosis correction with interpedicular screws reducing the number of levels required to incorporate and the number of procedures required to achieve adequate correction.