WHICH TECHNIQUE IS BEST? TRACTION BEFORE GENERAL ANESTHESIA OR UNDER GENERAL ANESTHESIA

Abstract

Aim: Supine lateral bending radiographs are the standard methods of evaluating curve flexibility before surgery in idiopathic scoliosis. Supine traction radiographs have also been used at the authors’ institution in addition to the supine lateral bending radiographs before surgery, believing that it is usually more helpful to analyze the response of the main and compensatory curves to corrective forces. The purpose of this prospective study was to use and evaluate the results of traction radiographs taken before general anesthesia (BGA) and under general anesthesia (UGA).

Material and Method: 25 patients required surgical treatment with idiopathic scoliosis were evaluated prospectively. Thirteen were female. The average age was 12.87 years. We designed a new electronic traction table in order to take the longitudinal traction and three-points lateral pressure radiographs. We situated the patient on the table and measured the patient’s weight. Then we made a longitudinal and lateral traction while asking the possible neurologic symptoms. If there was not any symptom we stopped at the seventy percent of the patient’s weight for the longitudinal and at the fifty percent for the lateral pressure. These radiographs had been taken before and under general anesthesia (UGA). The influence of the traction radiographies on the decision for surgery and its correlation with postoperative result was examined.

Results: Longitudinal traction radiographs taken consciously provided the best amount of flexibility, with no significant difference from traction with the patient UGA (p = 0.17) but with significant difference from bending radiographs (p < 0.002). No significant difference was demonstrated between the traction radiographies taken before and under general anesthesia and postoperative correction (P = 0.14).

Conclusion: The curve flexibility in supine traction films taken with the patient BGA was nearly equal to the curve flexibility in supine traction films taken with the patient UGA in all patients and all types of curves. Thus, there is no need to obtain a normal supine traction film for flexibility analysis under general anesthesia. By this way; the surgeons will be able to give the patient a definitive plan before surgery because the decision can be finalized after seeing the traction radiographs with the patient before the general anesthesia and operation time will be shorter.