Impact of Supine Radiographs to Assess Curve Flexibility in the Treatment of Adolescent Idiopathic Scoliosis.

Abstract

Retrospective cohort study. The purpose of the study is to evaluate the role of supine radiographs in determining flexibility of thoracic and thoracolumbar curves. Ninety operative AIS patients with 2-year follow-up from a single institution were queried and classified into MT structural and TL structural groups. Equations were derived using linear regression to compute cut-off values for MT and TL curves. Thresholds were externally validated in a separate database of 60 AIS patients, and positive and negative predictive values were determined for each curve. MT supine values were highly predictive of MT side-bending values (TL group: 0.63, <i>P</i> < 0.001; MT group: 0.66, <i>P</i> = 0.006). Similarly, TL supine values were highly predictive of TL side-bending values (TL group: 0.56, <i>P</i> = 0.001 MT group: 0.68, <i>P</i> = 0.001). From our derived equations, MT and TL curves were considered structural on supine films if they were ≥ 30° and 35°, respectively. Contingency table analysis of external validity sample showed that supine films were highly predictive of structurality of MT curve (Sensitivity = 0.91, PPV = 0.95, NPV = 0.81) and TL curve (Sensitivity = 0.77, PPV = 0.81, NPV = 0.94). ROC analysis revealed that the area under curve for MT structurality from supine films was 0.931 (SEM: 0.03, CI: 0.86-0.99, <i>P</i> < 0.001) and TL structurality from supine films was 0.922 (SEM: 0.03, CI- 0.84-0.98, <i>P</i> < 0.001). A single preoperative supine radiograph is highly predictive of side-bending radiographs to assess curve flexibility in AIS. A cut-off of ≥ 30° for MT and ≥ 35° for TL curves in supine radiographs can determine curve structurality.