Aim: Assessment of curve flexibility is important in decision making before surgical correction of scoliosis. Supine bending radiographs are presently the gold standard technique by which flexibility is assessed, but their reliability has been questioned. Our aim was to compare the usefulness of supine side bending and traction radiographs (with new electronic traction table) in assessing curve flexibility, examining the correlation of each technique with postoperative correction, determining fusion levels in patients undergoing posterior spinal fusion.

Material and Method: 25 patients required surgical treatment with idiopathic scoliosis were evaluated prospectively. Thirteen were female. The average age was 12.87 years. Preoperative radiologic evaluation consisted of standing anteroposterior, lateral, supine lateral bending and traction graphs by electronic traction table.

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 correction obtained in the Cobb angle between the bending and traction radiographs was compared. The influence of the traction radiography 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). Better flexibility in traction radiographs helped us eliminate the need for anterior release in 5 patients. We decreased the fusion levels proximally or distally after all in 12 patients. No significant difference was demonstrated between the traction radiography and postoperative correction (P = 0.14).

Conclusion: Flexibility obtained at traction radiographs with the patient conscious and UGA is clearly better in numerical values, and closer to the amount of surgical correction than the amount of flexibility at three-points lateral pressure radiographs and side-bending radiographs

This method benefits patients by allowing them to avoid anterior release surgery, assessing the fusion levels and helps predict postoperative correction. Longer follow ups are needed to see whether there is decompensation or not.