Surgical Correction Of Scoliosis Research Articles

Predictability of pulmonary function tests for intra- and post-operative cardiopulmonary complications of corrective surgery to treat scoliosis: a retrospective study.

This study was conducted to confirm the predictive power of preoperative pulmonary functions tests (PFTs) for intra- and post-operative cardiopulmonary complications during corrective surgery for scoliosis. A retrospective review of hospital charts of patients who underwent surgical correction for scoliosis and/or kyphosis at our medical center between September 2002 and September 2008 was performed. A total of 141 patients were enrolled in this study. The overall intra- and post-operative cardiopulmonary complication rate was 33.3% (47/141). There were 32 and 19 complications related to pulmonary issues (22.7%) and cardiovascular complications (13.5%), respectively. The complication rate of neuromuscular scoliosis (NMS) was 47.3% (35/74), while that of non-neuromuscular scoliosis (NNMS) was 17.9% (12/67). The cardiopulmonary complication rates of groups with FEV1 volumes below 1 L, 1-1.5 L, 1.5-2 L and over 2 L were 66.7% (18/27), 43.3% (13/30), 20.0% (7/35) and 18.4% (9/49), respectively. The group with FEV1 volumes below 1 L showed a significantly increased risk when compared to the group with FEV1 volumes over 2 L (P<0.05, Odds ratio = 5.15, multivariate logistic regression test). The cardiopulmonary complication rates of groups with FVC volumes below 1 L, 1-1.5 L, 1.5-2 L and over 2 L were 70.8% (17/24), 37.5% (9/24), 33.3% (11/33) and 16.7% (10/60), respectively. Additionally, the group with FVC volumes below 1 L showed significantly increased risk when compared to a group with FVC volumes greater than 2 L (P<0.001, Odds ratio = 8.0, multivariate logistic regression). The correction for NMS carries a higher complication rate than NNMS. Intra- and post-operative cardiopulmonary complication rates of a group with FEV1 or FVC volumes below 1 L were higher than the rates of groups with FEV1 and FVC volumes greater than 2 L.

Erfahrungen mit der operativen Therapie von Skoliosen bei Patienten mit Myelomeningozele

This study reports about the experiences in surgical correction of scoliosis, which were performed between 1984 and 1989 in 32 children with myelomeningocele. The average age at time of surgery was 14 years, 1 month; the average degree of scoliosis was 96 degrees preoperatively. 6 different types of surgical techniques were used. In comparison the best results were obtained by a combination of ventral osteodiscectomy with or without instrumentation and dorsal CD-instrumentation; an improvement of 56% was found. Furthermore we sent questionnaires to all patients, who were operated more then one year ago. The majority of them judges the improved sitting stability of the trunk to be the greatest advantage. There is a high rate of postoperative complications. Beside one death, which occurred intraoperatively, especially pseudarthroses of the lumbosacral junction must be mentioned. These pseudarthroses and a to short selected area of fusion are the main reasons for the loss of correction, which was noticed after a mean follow-up period of 24.6 months. The necessity of postoperative bracing was not reduced by using CD-instrumentation.

Surgical Correction of Scoliosis in Pediatric Patients With Cerebral Palsy Using the Unit Rod Instrumentation

Retrospective clinical and radiographic consecutive case series of 2 surgeons. The purpose of this study was to present a large consecutive series of patients with cerebral palsy who were treated with the Unit rod instrumentation at a single institution. The goal was to report the incidence of surgical complications, degree of deformity correction, reoperation rate, prevalence of pseudarthrosis, and the caretakers' perceived outcome. Children with cerebral palsy frequently develop scoliosis that requires surgical correction. Segmental instrumentation has been the primary mode of treatment. There are no reported large series with long-term follow up. This study was a retrospective review of 287 children treated with the Unit rod instrumentation. This instrumentation with fusion included the whole spine (between C7 and T3 into the pelvis) with 242 posterior-only and 45 anterior-posterior procedures. Of this group, 241 patients were observed for more than 2 years. This review focused on the rate of complications and radiographic outcome of the treatment. Parent and caretaker interviews were conducted to define perceived functional outcome after surgery. Scoliosis was corrected from a mean of 76 degrees to 25 degrees (68%). Pelvic obliquity was corrected from a mean of 17 degrees to 5 degrees (71%). In posterior-only procedures the average blood loss was 2.8 L, ICU stay was 4.9 days, and the hospital stay was 19.6 days. In combined procedures, the average blood loss was 3.4 L, ICU stay was 6.7 days, and the hospital stay was 24.5 days. Major complications included 3 perioperative deaths, 18 deep wound infections [12 early deep infections in a total of 287 patients (4.2%); 6 late deep infections in a total of 236 patients (2.5%)], and 2 patients with septicemia who recovered after prolonged antibiotic management. Caretakers' survey reported a 96% satisfaction rate. The Unit rod instrumentation is a common standard technique and the primary instrumentation system for the treatment of pediatric patients with cerebral palsy and neuromuscular scoliosis because it is simple to use, it is considerably less expensive than most other systems, and can achieve good deformity correction with a low loss of correction, as well as a low prevalence of associated complications and a low reoperation rate.

Incidence and Risk Factors of Neurological Deficits of Surgical Correction for Scoliosis

A retrospective study. To investigate the incidence of neurologic deficits after scoliosis correction at 1 institution and identify the risk factors for such deficits in scoliosis correction. Neurologic deficit is one of the risks of surgical correction of scoliosis. Reports of the incidence of the neurologic deficits involving a large number of cases at 1 institution are rare. Statistical analysis of the neurologic deficits was performed in 1373 scoliosis cases treated at 1 institution by etiologies in light of the patients' sex, age, sagittal profile, surgical approach, Cobb's angle, and the type of surgery. The total incidence of neurologic deficits was 1.89% and that of serious and mild ones was 0.51% and 1.38%, respectively. The total incidence of neurologic deficits were 1.06% in adolescent idiopathic scoliosis patients and 2.89% in congenital scoliosis (CS) patients, 3.32% in scoliosis patients with hyperkyphosis (>40 degrees ) and 1.38% in those without hyperkyphosis, 3.43% for combined procedures and 1.24% for single posterior procedures, 3.69% in patients with Cobb's angle more than 90 degrees and 1.45% in those with an angle less than 90 degrees , 1.68% with primary surgery and 5.97% with revision surgery, the difference between them was significant (P < 0.05). In adolescent idiopathic scoliosis patients, the incidence were 3.85% for combined procedures and 0.64% for posterior procedure, 0.82% with primary surgery and 8.33% with revision surgery, 4.17% with hyperkyphosis and 0.61% without hyperkyphosis, the difference between them was significant (P < 0.05). The incidence of CS patients with Cobb's angle more or less than 90 degrees were 7.23% and 1.68% and the difference was significant (P < 0.05). In surgical correction of scoliosis, the risk factors for neurologic deficits include CS, scoliosis with hyperkyphosis, scoliosis correction by combined procedures, scoliosis with a Cobb's angle more than 90 degrees , and a revision surgery.

Surgical correction of scoliosis in children with congenital heart failure (Fontan circulation): case report and literature review

Patients with Fontan circulation represent a significant cardiorespiratory risk during spinal surgery. We report about two patients with severe scoliosis and Fontan circulation and their successful operative treatment. The case report will be compared with the national and international literature.

Late presentation of superior mesenteric artery syndrome following scoliosis surgery: a case report

IntroductionObstruction of the third part of the duodenum by the superior mesenteric artery (SMA) can occur following surgical correction of scoliosis. The condition most commonly occurs in significantly underweight patients with severe deformities during the first few days to a week following spinal surgery.Case presentationWe present the atypical case of a patient with normal body habitus and a 50° adolescent idiopathic thoracolumbar scoliosis who underwent anterior spinal arthrodesis with instrumentation and developed SMA syndrome due to progressive weight loss several weeks postoperatively. The condition manifested with recurrent vomiting, abdominal distension, marked dehydration, and severe electrolyte disorder. Prolonged nasogastric decompression and nasojejunal feeding resulted in resolution of the symptoms with no recurrence at follow-up. The spinal instrumentation was retained and a solid spinal fusion was achieved with good spinal balance in both the coronal and sagittal planes.ConclusionSMA syndrome can occur much later than previously reported and with potentially life-threatening symptoms following scoliosis correction. Early recognition of the condition and institution of appropriate conservative measures is critical to prevent the development of severe complications including the risk of death.

Incidence and Risk Factors Associated with Superior Mesenteric Artery Syndrome following Surgical Correction of Scoliosis

Study DesignRetrospective study.PurposeTo more accurately determine the incidence and clarify risk factors.Overview of LiteratureSuperior mesenteric artery syndrome is one of the possible complications following correctional operation for scoliosis. However, when preliminary symptoms are vague, the diagnosis of superior mesenteric artery syndrome may be easily missed.MethodsWe conducted a retrospective study using clinical data from 118 patients (43 men and 75 women) who underwent correctional operations for scoliosis between September 2001 and August 2007. The mean patient age was 15.9 years (range 9~24 years). The risk factors under scrutiny were the patient body mass index (BMI), change in Cobb's angle, and trunk length.ResultsThe incidence of subjects confirmed to have obstruction was 2.5%. However, the rate increased to 7.6% with the inclusion of the 6 subjects who only showed clinical symptoms of obstruction without confirmative study. The BMI for the asymptomatic and symptomatic groups were 18.4±3.4 and 14.6±3, respectively. The change in Cobb's angle for the asymptomatic and symptomatic groups were 24.8±13.6° and 23.4±9.1°, respectively. The change in trunk length for the asymptomatic and symptomatic groups were 2.3±2.1 cm and 4.5±4.8 cm, respectively. Differences in Cobb's angle and the change in trunk length between the two groups did not reach statistical significance, although there was a greater increase in trunk length for the symptomatic group than for the asymptomatic group.ConclusionsOur study shows that the incidence of superior mesenteric artery syndrome may be greater than the previously accepted rate of 4.7%. Therefore, in the face of any early signs or symptoms of superior mesenteric artery syndrome, prompt recognition and treatment are necessary.

102. Incidence and Risk Factors of Neurological Deficits of Surgical Correction for Scoliosis: Analysis of 1373 Cases at One Chinese Institution

BACKGROUND CONTEXT: A retrospective study was designed to analyze the incidence of neurological deficits among 1373 patients with scoliosis undergoing surgical correction and investigate the risk factors at one Chinese institution.

2007 Argos thesis award Finite element simulation of various strategies for scoliosis surgical correction

The numerical simulation for the scoliosis surgical correction could be helpful in establishing the best surgical planning for a given patient. Previous research at the Laboratoire de Bioécanique yielded a preliminary finite-element model, and demonstrated the feasibility of a patient-specific simulation. However its extreme tediousness and its lack of self-reliance made it difficult to be used in a clinical environment. The objective of our work is to take ever this finite-element model, in order: first, to improve two key-parameters, i.e. automation for the assessment of patient-specific mechanical properties, and robustness (numerical stability and self-reliance) for the simulation of surgery. Second, to model various clinical cases in order to ewaluate the clinical relevance of the model and to better understand mechanisms of correction.

Going it alone: Technician led theatre monitoring for the surgical correction of scoliosis

Going it alone: Technician led theatre monitoring for the surgical correction of scoliosis

CORRELATION BETWEEN THE RATE OF DECOMPENSATION IN SPINAL MEMBRANE BLOOD CIRCULATION, THE MAGNITUDE OF SPINAL DEFORMITY AND THE OUTCOMES OF SURGICAL TREATMENT IN PATIENTS WITH IDIOPATHIC SCOLIOSIS

Objective. To study microcirculation in spinal membranes, and its correlation with the magnitude of spinal deformity and the outcomes of surgical treatment in patients with grade III–IV idiopathic scoliosis. Material and Methods. Intraoperative laser Doppler flowmetry was performed to measure microcirculation in spinal membranes at the deformity apex and adjacent segments during surgical correction of scoliosis in 10 patients at the age of 14 to 17 years. Results. It was revealed that the volumetric capillary blood flow in spinal membranes at the deformity apex was decreased by 27–57 % as compared to sufficient level. Decompensation of microcirculation in membranes was more expressed in Sshaped deformity. Blood flow reduction is in direct relation to the angle of spine deformity. Spine deformity correction with intraoperative distraction measuring from 5 to 20 mm could cause neurologic complications if blood flow in spinal membranes at the apex of deformity is less than 20ml/min per 100 g and cranial blood flow ranges from 18 to 40 ml/min per 100 g. These patients should be treated with a more sparing intraoperative distraction of the spine (≤5 mm) followed by conservative enhancement of spinal cord microcirculation. Conclusion. Parameters of volumetric capillary blood flow in spinal membranes at the deformity apex and adjacent segments could be used for prediction of neurological complications in surgical correction of idiopathic scoliosis.

Effectiveness of Arndt endobronchial blockers in pediatric scoliosis surgery: a case series

Pediatric scoliosis surgery may require single lung ventilation for surgical access. Current methods of lung isolation are inadequate for some or all of these children. The Arndt endobronchial blocker (EBB) has been described for use in pediatric thoracic surgery to enable single lung ventilation (SLV). There are few data on its use in pediatric spinal deformity surgery. We report the successful use of the Arndt EBB in a series of these patients. Any patient undergoing surgical correction of scoliosis involving a lateral thoracotomy for an anterior approach was managed with an Arndt EBB (5, 7 and 9 Fr gauge) to facilitate SLV. All cases were undertaken by a pediatric anesthetist trained in pediatric bronchoscopy; a 2.2 or 2.8 mm pediatric fiberoptic scope was used for placement and positional confirmation. Patients' ages and weights ranged from 18 months to 18 years, and from 9.4 to 71 kg. All had idiopathic or congenital scoliosis; one underwent a vertical expansion prosthetic titanium rib (VEPTR) procedure. In all 20 patients, placement was easily and quickly achieved with no incorrect placements. There was one displacement after inflation, quickly corrected. Right upper lobe deflation proved difficult in one patient with high take-off of the right upper lobe bronchus. The surgical field was excellent in all cases. In our case series, Arndt EBB provided a safe and highly effective means of single lung isolation for children undergoing pediatric scoliosis surgery.

The effectiveness of ARNDT endobronchial blockers in paediatric scoliosis surgery

Introduction: Although described for paediatric thoracic surgery (1), there is little data on the use of the Arndt endobronchial blocker in paediatric spinal deformity surgery. We present its successful application in these patients.Methods: Thirteen patients undergoing surgical correction of scoliosis involving a lateral thoracotomy anterior approach were suitable for lung isolation using an Arndt endobronchial blocker. Placement was via an armoured tracheal tube; the endobronchial blockers were 5 or 9 FG with low‐volume low‐pressure cuffs (spherical or elliptical balloons). Placement was by a paediatric anaesthetist trained in paediatric bronchoscopy and required a 2.2 or a 2.8 mm paediatric fibreoptic bronchoscope.Results: Patient ages ranged from 18 months to 18 years and weights from 9 kg to 71 kg. All had idiopathic or congenital scoliosis; one patient underwent a VEPTR procedure. In all 13 patients, placement was easily and promptly achieved with no incorrect placements, displacements (including after patient repositioning), or failures to isolate one lung. Median time of insertion was 5 min (with checks), speed of insertion increasing as experience improved. Inflation times for the blocker balloon ranged from 1.5 h to 5 h. There was no airway trauma; direct bronchial inspection revealed local erythema only. Saturations were supported with 5 cm CPAP to the isolated lung and one‐lung ventilation was well tolerated in all but one patient with acceptable airway pressures (&lt;35 cm water); this one patient required partial lung inflation (blocker in place, balloon not inflated) to maintain adequate saturations and airway pressures. The surgical field was excellent in all cases.Discussion: Complex paediatric spinal surgery may require lung collapse to improve spinal access, and is traditionally achieved using a double‐lumen tracheal tube. Difficulties can arise as the children are often small for age with potentially distorted airway anatomy and there are a limited number of double lumen tube sizes. This can lead to inadequate isolation, a poor surgical field, endobronchial cuff herniation or obstruction of left upper lobe (tube too small or too long). The careful use of the Arndt endobronchial blocker avoids all these problems and enables easy reliable and safe isolation. Potential complications include malposition, migration, and direct airway trauma, allied to the usual complications of one lung anaesthesia. In our series, there were no complications relating to its use and insertion was quick and straightforward.Conclusions: Lung isolation with the Arndt endobronchial blocker is both safe and very effective in paediatric spinal deformity surgery.Reference 1 Wald SH, Mahajan A, Kaplan MB et al. Experience with the Arndt paediatric bronchial blocker. Br J Anaesth 2005; 94: 92–94.

Spinal anesthesia using a continuous spinal catheter for cesarean section in a parturient with prior surgical correction of scoliosis

This case report demonstrates the successful anesthetic management of cesarean section for a 29-year-old primiparous parturient with a past history of a scoliosis operation at 13 years of age. An Isola hook and screw-rod system had been implanted as posterior spinal instrumentation at the level of T3-L3. We titrated hyperbaric bupivacaine 7 mg combined with fentanyl 15 microg through a continuous spinal catheter, placed with a catheter-over-needle technique in order to avoid unintentional wide spread of anesthetic agents. The anesthetic level was T4 at the start of the operation. Her surgery was carried out without any problems. Headache, as a dural tap-related complication, was not observed. Spinal anesthesia with the titration of anesthetic agents for cesarean section is considered to be one of the choices for a parturient who has had spinal instrumentation.

Monitoring of scoliosis surgery with epidurally recorded motor evoked potentials (D wave) revealed false results

Objective To elucidate the mechanism behind D wave amplitude changes after surgical correction of scoliosis. Methods We collected D wave and muscle MEP data from 93 patients (78 female, 15 male, age range 4–19 years, mean age 15.9 years), who underwent surgical correction of scoliosis. D waves were recorded via a catheter electrode inserted epidurally through the flavectomy. Muscle MEPs from lower limb muscles were also recorded. Muscle MEPs/D wave were elicited by short trains/single transcranial electrical stimuli. SEPs were elicited through bilateral percutaneous stimulation of the tibial nerves at the ankle and an averaged response from 100 to 200 single sweeps were recorded over the scalp at Cz’/Fz. In addition, we analyzed intraoperatively obtained X-ray images of the spine in 9 patients and preoperative spinal MRI in two of those nine. Results After surgical correction of scoliosis in 25 of 93 (27%) patients, the D wave amplitude changed by more than 20% of its baseline value. A decremental change occurred in 21 (84%) and an incremental change in 4 (16%) patients. D wave decrements of more than 50% were observed in 5 patients without significant SEP changes in any of these cases. In 9 patients, intraoperatively obtained X-rays of the spine (before and after correction of spine curvature) showed no catheter displacement. Muscle MEPs did not change and postoperative sensory-motor status was normal. In 2 patients, preoperative MRI revealed displacement of the spinal cord towards the concave side of the scoliotic curvature. Conclusions During scoliosis surgery, D wave amplitude changes should be interpreted cautiously until the definitive cause(s) of these changes are found. One possible mechanism to explain D wave changes during scoliosis correction could involve rotation of the spinal cord within the spinal canal, and the relative position of the epidural recording catheter (ERC). Rotation of the spinal cord after correction of scoliosis could introduce a new relationship between the ERC and the corticospinal tracts (CTs). Due to high incidence of false D wave amplitude changes we suggest that this methodology should not be used to assess the functional integrity of the CTs during scoliosis surgery. Significance This study provides new insight into the methodology of D wave monitoring as well as strong evidence of a high incidence of false positive results using D wave monitoring during surgical correction of scoliosis.

Mechanisms of scoliosis surgical correction related to Cotrel-Dubousset and in situ contouring techniques

This paper presents a finite element model to simulate and optimize the bending forming process of a Commercially Pure (CP) titanium part for instrumentation intended to correct scoliotic deformations. The numerical tool is used as a technological indicator, in particular to anticipate tool dimensions compensating for the springback after bending. The mechanical behaviour of material is studied from uniaxial tensile tests with an image analysis measurement method for the determination of strain fields. The experimental results are then used to identify the intrinsic behaviour of the CP titanium and the parameters of an anisotropic elastic–plastic model. The numerical simulation is carried out on a reference part manufactured by the industrial partner. The study reveals that the numerical outline is in agreement with the measurements carried out on the part if the springback after bending is taken into account. The influence of the opening angle of the punch and die on this phenomenon is finally discussed through a parametric study.

The Superior Mesenteric Artery Syndrome in Patients with Spinal Deformity

A retrospective review. To determine the incidence of the superior mesenteric artery syndrome (SMAS) after surgical correction for scoliosis and if it is influenced by newer derotation/translation surgical systems. The SMAS is a known complication after surgery. Of 2939 charts reviewed, 17 patients between 1960 and 2002 matched inclusion criteria. Our incidence of the SMAS was 0.5%. Onset of symptoms was 7.2 days. Several scoliosis diagnoses were included in the study group. Instrumentation that was used included: nondistraction systems (n = 14), Harrington rod with body cast (n = 1), Luque rod with sublaminar wires (n = 1), and casted in situ posterior spinal fusion (n = 1). Before surgery, 10 of 17 patients weighed less than the 50th percentile. Mean preoperative BMI was 18.6 kg/cm/cm. Postoperative height gain averaged 3.175 cm, and weight loss at onset of symptoms averaged 4.5 kg. There were 14 patients who required nasogastric suction for an average duration of 10.2 days, 11 required hyperalimentation, and 5 concurrently received hyperalimentation with enteric feeding. The SMAS recurred in 2 patients. Postoperative weight loss appears to be more important for the development of the SMAS than asthenic body type. Newer derotation/translation corrective techniques have not eliminated the SMAS. Gastrointestinal imaging is indicated when nausea and vomiting occur 6-12 days after surgery, associated with early satiety and normal bowel sounds. Decompression and nutritional support remain the mainstays of treatment.

Clinical Usefulness of Somatosensory Evoked Potentials for Detection of Brachial Plexopathy Secondary to Malpositioning in Scoliosis Surgery

A retrospective longitudinal study of 434 consecutive pediatric patients who underwent surgical correction of scoliosis, while being monitored for positional brachial plexopathy. To evaluate the effectiveness of intermittent monitoring of ulnar nerve somatosensory evoked potentials (SSEPs) for detecting brachial plexus injury caused by malpositioning during scoliosis surgery. Continuous intraoperative SSEP monitoring for spinal cord function has been well reported, and is widely accepted as the standard for spinal deformity correction surgery to detect and avoid neurologic injury. The use of SSEPs for the monitoring of ulnar nerve function intraoperatively as an indicator of brachial plexus function is becoming more accepted as a valid and useful technique to minimize intraoperative neurologic injuries during deformity corrections. A review was conducted to assess the effect of ulnar nerve SSEP monitoring, as a measure of brachial plexus function, during anterior, posterior, or combined approach surgeries. The type of scoliosis, type of surgery and positioning, and surgical event at noted amplitude decrease were included in an analysis of variance for repeated measures, and a Student t test was performed for significant differences. A total of 27 patients had ulnar nerve amplitude decreases of > or =30%, resulting in a point prevalence of 6.2% for positional brachial plexopathy during positioning for all scoliosis surgeries. A significant difference was noted between the types of positioning, with prone positioning accounting for a higher rate of brachial plexopathy compared with anterior approach positioning (P < 0.01). No statistical difference exists as to the type of scoliosis present and the incidence of brachial plexopathy (P < 0.01). Avoidance of neurologic injury to the brachial plexus during scoliosis surgery is possible by early detection with ulnar nerve SSEP monitoring.

EXPERIENCE IN APPLICATION OF UNIVERSAL DORSAL INSTRUMENTATION FOR SCOLIOSIS TREATMENT

Objective. The objective of the study was the development of optimal, i.e simple, safe, and effective instrumentation for treatment of adolescent and adult scoliotic deformities. Material and Methods. The paper presents the results of surgical treatment in 23 patients with thoracic and thoracolumbar scoliosis with application of novel dorsal instrumentation developed at the Chair of Traumatology and Orthopaedics of the Russian University of Peoples’ Friendship. Twenty three patients at the mean age of 15.6 years (range, 11–44 years) with Grade IV thoracic and thoracolumbar scoliosis were operated on. The smallest Cobb angle of deformation was 61°, the largest – 96°. Surgical correction of scoliosis was performed with application of universal dorsal instrumentation. The follow-up period was 1 year. Results. The correction of Grade IV deformation with Cobb angle from 61 to 70° was 85.2–91.8 %; with Cobb angle from 71 to 80° was 83.8–90.5 %. The curvature from 81 to 96° was corrected by 65.6–73 % by single-stage operation. Conclusion. The suggested universal instrumentation for spine scoliosis correction is a hi-tech technique. Its advantages are the simple and safe application, good correction in three planes of deformation, the possibility of use both in children and in adults, and the absence of spine growth restriction in children.

Traction Radiography Performed under General Anesthetic: A New Technique for Assessing Idiopathic Scoliosis Curves

A prospective review of 24 patients with late-onset idiopathic scoliosis. OBJECTIVES.: To compare curve flexibility measured using supine bending radiography and traction radiography; to examine the correlation of each technique with postoperative correction; and to determine the influence of each technique on the decision to perform concomitant anterior release surgery with posterior instrumentation. Assessment of curve flexibility is important in decision making before surgical correction of scoliosis. Supine bending radiographs are presently the gold standard technique by which flexibility is assessed, but their reliability has been questioned. No literature has shown a conclusively superior role for traction radiography in assessing idiopathic scoliosis curves. Each patient had erect anteroposterior radiographs and supine bending radiographs. On the day of surgery, traction radiography was performed under general anesthetic. The correction obtained in the Cobb angle between the bending and traction radiographs was compared. The influence of the traction radiography on the decision for anterior release surgery and its correlation with postoperative result was examined. Traction radiography demonstrated significantly greater curve flexibility than supine bending radiographs (P < 0.001). Eleven of 13 patients planned for anterior release surgery and posterior instrumentation avoided anterior release after review of the traction radiography. No significant difference was demonstrated between the traction radiography and postoperative correction (P = 0.13). Traction radiography is superior to supine bending radiography in assessing curve mobility before surgery. This method benefits patients by allowing them to avoid anterior release surgery and helps predict postoperative correction.