Abstract
ABSTRACT Objective: To determine the preoperative radiographic method for measuring the Cobb angle that is closest to the postoperative result in patients with scoliotic deformity. Methods: Retrospective cohort study of radiographic spinal evaluation (preoperative posteroanterior (PA), bending, traction, traction under anesthesia and immediate postoperative posteroanterior (PO)) of 26 patients treated surgically for scoliotic deformities during the period from January 2017 to September 2019. The final mean Cobb angle and its decrease in relation to the PA value were evaluated in the three curves in patients with idiopathic (IS) and non-idiopathic scoliosis. Results: All the mean curve values were statistically significant, except for bending in non-idiopathic scoliosis (non-IS). The mean traction under anesthesia values were closer to the PO values. Regarding the delta (decrease) of the maneuvers in relation to the PA, no statistical significance was observed in the non-IS group. The traction under anesthesia maneuver had a greater delta in all curves. Conclusions: The traction under anesthesia maneuver in patients with idiopathic scoliosis is the method with the greatest flexibility and which best predicts the postoperative result. Level of evidence III; Diagnostic study.
Highlights
Scoliosis is the most common spinal deformity in children and adolescents
The final mean Cobb angle and its decrease in relation to the PA value were evaluated in the three curves in patients with idiopathic (IS) and non-idiopathic scoliosis
This study proposes measuring the Cobb angle in standing, bending, traction and traction under anesthesia positions for a comparative analysis of coronal plane flexibility in order to predict the method that most closely matches the postoperative results of patients with scoliosis
Summary
It is defined as a three-dimensional deformity with curvature greater than 10 degrees in the coronal plane, associated with rotation of the vertebral bodies and it can be classified into two large groups: idiopathic and non-idiopathic.[1] The Cobb angle is the main method used to measure the curve, its progression and to define the treatment.[2] In their classifications, King[3] and Lenke[4] highlighted the importance of the flexibility of the curves in the radiographical examination, formulating the concept of curve structurality and defining it as one of the most important parameters for surgical planning, responsible for the choice of arthrodesis levels and the number of corrective osteotomies.[5,6,7,8,9] Flexibility can be analyzed by several methods: bending in the standing or dorsal horizontal decubitus positions, fulcrum bending, traction, traction under general anesthesia, among others.[5,6,7,10,11,12]. There are still no studies that prove which curve flexibility assessment method is closest to the postoperative result.[15]
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