Fulcrum- and Side-bending Radiographs Both Useful for Scoli Surgery

We’ve known for awhile that the fulcrum-bending radiograph is predictive of correction after AIS surgery; this elegant study shows one of its limitations, and identifies a good alternative

What’s the Claim?

Surgeons who perform corrective surgery for adolescent idiopathic scoliosis need preoperative radiographs to anticipate the amount of correction, but available evidence disagrees about the best approach. An elegant comparative study from Japan found that correction observed on a fulcrum-bending radiograph — which involves placing the patient in the lateral position and bending the patient’s spine over a fulcrum to passively “hinge” the spine open — correlated well with the correction angle of the structural curve, and the typical side-bending radiograph anticipated the correction of the nonstructural curve. These findings held out to a year of follow-up. The authors were able to read these radiographs with a high level of reliability (inter-rater intraclass correlation coefficients of 0.98 to 0.99).

How’s It Stack Up?

The technique for a fulcrum-bending radiograph has been around for 25 years, and although most studies of its use found it to be effective, the authors of this study were concerned that it might not be as effective as the side-bending radiograph for assessing the nonstructural curve. They were correct. That question hasn’t been much explored, and so the authors’ finding is useful.

What’s Our Take?