THE VALUE OF FORCED TRACTION UNDER ANAESTHESIA AND FULCRUM BENDING VIEWS IN PREDICTING CURVE FLEXIBILITY IN LARGE CURVES FOR IDIOPATHIC SCOLIOSIS.

Abstract

Introduction: There has been controversy in recent publications for/against the value of intraoperative traction views under anaesthesia, both studies had patients with a mean standing cobb angle of 55o failing to show the predictive value of these views for curves greater than 60o.

Design: Compare predictive value of fulcrum bending views with intraoperative forced traction under anaesthesia (FTUGA) views in predicting curve flexibility; influencing the correction of curves greater than 60^o in scoliosis deformity.

Subjects: 35 patients with idiopathic scoliosis undergoing surgical correction; mean age was 19 yrs (9–40), the student’s t test and χ2 were used to assess the reliability of FTUGA views in predicting curve flexibility, degree of correction the fulcrum bending correction index (FBCI) used to measure curve flexibility and correction.

Results: The mean preoperative major curve standing and fulcrum bending views Cobb angle was 72^o (50–90), 59^o (20–82) respectively, and 37^o (14–54) on traction views. Posterior correction was performed in all patients. The mean postoperative major curve Cobb angle was 27 (10–54). The number of patients predicted for combined anterior release and posterior instrumentation was reduced from 22 to 3.

Predictive value for traction view according to standing Cobb angle was P=0.1 for Cobb angles (50–59), P=0.1 for Cobb angles (60–69), P= 0.01 for Cobb angle (70–79), P=0.01 for Cobb angle (80–90). P value for the difference between fulcrum bending views, traction views and post op correction P=0.001 in favour of traction views, the mean curve flexibility was 33%, 55% for fulcrum and traction respectively. Mean fulcrum bending and traction correction index were 232%, 123% respectively.

Conclusion: Forced Traction Under General Anaesthesia views were superior in predicting curve flexibility in curves that measured more than 70^o but weak predictor of final correction angle when performing posterior scoliosis correction.