Adolescent Idiopathic Scoliosis Clinical Trial
Official title:
Comparison of Dynamic Radiographs in Determining Fusion Level in Adolescent Idiopathic Scoliosis Correction
The purpose of this study is to identify the flexibility radiograph(s) that can most accurately predict the curve behaviour after surgical correction of AIS. With these findings, the investigators hope to give further guidance for the selection of fusion levels and to incorporate different dynamic radiographs into the Lenke Classification, leading to a more universal application that can consistently lead to good surgical and clinical outcome.
The Lenke Classification is the most widely-accepted classification for Adolescent Idiopathic
Scoliosis (AIS) in the world. Its recommendations for fusion of the minor curves depend on
its structurality. It defines a minor curve as structural if there is inflexibility on
side-bending more than 25 . However, a recent Delphi survey from a panel of experts in AIS
management showed that there was no consensus as to which type of dynamic radiograph was
optimal. Up to two thirds of the surgeons did not use side-bending as a routine, and hence
they cannot apply the Lenke Classification accurately in clinical practice nor follow its
recommendations for fusion.
Furthermore, the current classification does not give specific recommendations regarding the
selection of fusion levels and does not take into account the clinical appearance of the
patients which impact on treatment. Consequently, there are still controversies regarding the
Upper Instrumented Vertebra (UIV) and Lowest Instrumented Vertebra (LIV) selections, and
following the recommendations may not allow fusion of the least number of segments nor give
best clinical results eg shoulder balance.
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