The use of fulcrum bending radiographs in anterior thoracic scoliosis correction: a consecutive series of 90 patients

Study Design. A prospective, consecutive series of 90 patients receiving fulcrum bending radiographs before endoscopic anterior scoliosis correction. Objective. To assess the effectiveness of fulcrum bending radiographs in predicting correction of the structural curve in anterior scoliosis surgery for a series of 90 consecutive patients. Summary of Background Data. The fulcrum bending radiograph is highly predictive of scoliosis curve correction for posterior instrumented fixation. However, its use has been questioned in relation to anterior scoliosis surgery due to the disc removal in anterior procedures. Methods. Fulcrum bending radiographs were performed before endoscopic anterior scoliosis correction following the protocol of Cheung and Luk. All patients received a single anterior rod and vertebral body screws using a standard compression technique. In all cases, cleared disc spaces were packed with mulched femoral head allograft. Surgical correction was assessed using 6- to 8-week postoperative standing radiographs. Paired t tests and least squares linear regression analysis were used to compare the preoperative major Cobb angle achieved on the fulcrum bending radiograph with the postoperative Cobb angles for each patient. Results. Mean (+/-SD) major curve correction rate was 60.1% +/- 12.4%. Mean instrumented curve correction rate was 63.7% +/- 11.7%. Mean fulcrum flexibility was 60.8% +/- 15.5%. Mean fulcrum bending correction index was 104%. There was no statistically significant difference between the mean fulcrum bending radiograph Cobb angle (20.4 +/- 9[degrees]) and the mean postoperative major Cobb angle for the structural curve (20.5 +/- 7.1[degrees]). Conclusion. The results of this study show that fulcrum bending radiographs are predictive of surgical correction for anterior scoliosis surgery