Pre-operative prone radiographs can reliably determine spinal curve flexibility in adolescent idiopathic scoliosis (AIS)

Tej Joshi, Daniel C. Berman, Soroush Baghdadi, Evan Mostafa, Jaime A. Gomez, Regina Hanstein, Leila Mehraban Alvandi, Jacob F. Schulz

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The purpose of this study was to evaluate the correlation between non-effort prone and bending radiographs in determining curve flexibility in adolescent idiopathic scoliosis (AIS). Methods: A retrospective review of AIS patients who underwent pre-operative full spine radiographic imaging from 2006 to 2019 was performed. The Cobb angle (CA) of proximal thoracic (PT), main thoracic (MT) and thoracolumbar/lumbar (TL/L) curves were measured and correlated on standing, prone and bending radiographs. Standing, bending, and prone measurements were correlated using Spearman’s analysis, and intra-rater reliability was evaluated using intraclass correlation analysis. Results: A total of 381 patients (74% female) with a mean age of 15.1 ± 2.5 years were identified. A strong correlation existed between the prone and bending CA for the PT (rs = 0.797, p < 0.01) and MT (rs = 0.779, p < 0.01) curve and a moderate correlation existed between the prone and bending TL/L curve (rs = 0.641, p < 0.01). For a non-structural PT curve, a prone CA < 25° correctly identified a bending CA < 25° 96.7% of the time (p < 0.005). For a non-structural MT curve, a prone CA < 35° correctly identified a bending CA < 25° 90.2% of the time (p < 0.005). For a non-structural TL/L curve, a prone CA < 35° correctly identified a bending CA < 25° 95% of the time (p < 0.005). Conclusion: Prone radiographs demonstrated a moderate to strong correlation with bending radiographs and may be used as a proxy for determining spinal flexibility, especially when bending films are deemed unreliable. Level of evidence: III.

Original languageEnglish (US)
Pages (from-to)1063-1070
Number of pages8
JournalSpine deformity
Volume10
Issue number5
DOIs
StatePublished - Sep 2022

Keywords

  • Adolescent idiopathic scoliosis
  • AIS
  • Bending
  • Curve flexibility
  • Posterior spinal fusion
  • Prone
  • Radiographs

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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