Kusumoto Hirofumi, Tetreault Tyler A, Heffernan Michael J, Sponseller Paul D, Cheung Kenneth M C, Gomez Jaime A, Hwang Steven W, Gupta Purnendu, Andras Lindsay M
Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Eur Spine J. 2025 Mar 20. doi: 10.1007/s00586-025-08740-0.
Despite agreement on the importance of spinal curvature flexibility in surgical decision making, there is no consensus regarding optimal radiographic assessment and how this impacts care. We sought to further understand traction film indications and techniques.
A nine-question survey was administered to 194 members of the Pediatric Spine Study Group (PSSG). The survey aimed to elucidate flexibility radiograph practices of pediatric spine surgeons and how these results inform operative plans and timing.
Ninety-six of 194 (49.5%) respondents were included in the analysis. 96.9% (93/96) performed radiographic assessment of curve flexibility. Amongst these surgeons, roughly half (52.7%, 49/93) do so for surgical planning only (level selection, osteotomies, construct type, etc.), while 45.2% use them for both surgical planning and surgical timing. Radiographs performed included: supine traction (68.8%, 64/93), supine bending (61.3%, 57/93), standing bending (39.8%, 37/93), supine without traction (20.4%, 19/93), and other (21.5%, 20/93). Supine traction films were typically performed by one person holding the legs and one pulling the arms (62.5%, 40/64) or pulling the chin or head (23.4%, 15/64). Traction is routinely applied by physicians (48.4%, 45/93), radiology technicians (39.8%, 37/93), and physician assistants (20.4%, 19/93). Nearly half (45.2%, 45/93) of surgeons feel that traction films are not a consistent or reproducible measure within their department, and 68.8% (64/93) feel that these films are not reproducible across institutions.
The marked variability observed amongst institutional practices and concerns about reproducibility within and across departments warrant the development of a more standardized method to assess curve flexibility.
尽管在脊柱弯曲灵活性对手术决策的重要性方面已达成共识，但在最佳影像学评估及其如何影响治疗方面尚无定论。我们试图进一步了解牵引片的适应证和技术。
对小儿脊柱研究组（PSSG）的194名成员进行了一项包含9个问题的调查。该调查旨在阐明小儿脊柱外科医生的灵活性X线片检查实践，以及这些结果如何为手术计划和时机提供依据。
194名受访者中有96名（49.5%）纳入分析。96.9%（93/96）的受访者进行了脊柱弯曲灵活性的影像学评估。在这些外科医生中，约一半（52.7%，49/93）仅在手术规划时进行评估（节段选择、截骨术、内固定类型等），而45.2%的医生在手术规划和手术时机方面均会使用。所进行的X线片检查包括：仰卧位牵引（68.8%，64/93）、仰卧位弯曲（61.3%，57/93）、站立位弯曲（39.8%，37/93）、无牵引仰卧位（20.4%，19/93）以及其他（21.5%，20/93）。仰卧位牵引片通常由一人握住双腿，另一人牵拉双臂（62.5%，40/64）或牵拉下巴或头部（23.4%，15/64）。牵引通常由医生（48.4%，45/93）、放射技师（39.8%，37/93）和医师助理（20.4%，19/93）进行。近一半（45.2%，45/93）的外科医生认为牵引片在其所在科室并非一种一致或可重复的测量方法，68.8%（64/93）的医生认为这些片子在不同机构间不可重复。
各机构实践中观察到的显著差异以及对科室内部和科室之间可重复性的担忧，使得有必要开发一种更标准化的方法来评估脊柱弯曲灵活性。
