Comparison of slot-scanning standing, supine, and fulcrum radiographs for assessment of curve flexibility in adolescent idiopathic scoliosis: a pilot study.

PURPOSE

With the goal of reducing radiation dosing for patients, we sought to compare the results of slot-scanning (EOS) standing flexibility radiographs to supine bending and fulcrum radiographs for surgical planning in adolescent idiopathic scoliosis (AIS). We hypothesized that slot-scanning standing bending radiographs provide similar mean curve flexibility as supine bending and fulcrum radiographs.

METHODS

This is a retrospective review of 224 AIS patients with concomitant upright standing and flexibility images. Curve flexibility, defined the percent change in Cobb angle from standing upright to flexibility images, was used to compare the results of slot-scanning standing, supine and fulcrum radiographs. Statistical analysis utilized ANOVA one-way tests and two-sample t tests to detail differences as indicated.

RESULTS

A total of 256 imaging studies were included, 75 slot-scanning standing, 112 supine, and 69 fulcrum radiographs. Fulcrum images only investigated thoracic curves and were, therefore, excluded from proximal thoracic and lumbar flexibility comparisons. Relevant mean standing curve magnitudes were similar between the groups with some variance in thoracic curves between fulcrum and supine image series (p = 0.003). There was no statistical difference in curve flexibility for proximal thoracic curves (p = 0.389) and lumbar curves (p = 0.798). However, for thoracic curves, slot-scanning standing images result in less measured curve flexibility compared to supine (p = 1.00E-7) and fulcrum images (p = 2.84E-18). Furthermore, supine bending images resulted in less measured curve flexibility in comparison to fulcrum images (p = 2.85E-7).

CONCLUSION

Slot-scanning standing bending films show comparable results in curve flexibility as supine bending films for proximal thoracic and lumbar curves but may show reduced flexibility for thoracic curves when compared to supine or fulcrum bending films. Given lower radiation dosing, slot-scanning films could be substituted for traditional supine films for assessment of proximal thoracic and lumbar curve flexibility.