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Forced Lordosis on the Thoracolumbar Junction Can Correct Coronal Plane Deformity in Adolescents With Double Major Curve Pattern Idiopathic Scoliosis

van Loon, Piet J. M., MD*; Kühbauch, Bob A. G., MD*; Thunnissen, Frederik B., MD, PhD

doi: 10.1097/BRS.0b013e3181694ff5

Study Design. A prospective radiographic study was conducted.

Objective. To support our hypothesis that correction of the scoliosis may benefit from a lordotic fulcrum force in the sagittal plane on the thoracolumbar spine.

Summary of Background Data. Adolescent idiopathic scoliosis is an important spinal deformity. Correction can be achieved with limited options by current bracing techniques. Lateral bending radiographs are used to assess flexibility and predict treatment outcome. The corrective potential of a lordotic fulcrum force in the sagittal plane has not been addressed.

Methods. Anterioposterior spine radiographs of patients with a double major curve pattern scoliosis were obtained in 2 groups of patients. In group A radiographs in 3 positions: standing, and supine with and without fulcrum (n = 12), and group B radiographs in 2 positions (n = 28): standing, and supine with lordotic fulcrum. Cobb angles were determined and evaluated statistically. The sagittal contour of the thoracolumbar junction in standing position was measured.

Results. In group A with the patients lying supine a correction of the Cobb angle was obtained at the thoracic level of 15.4% and the lumbar level of 27.5% (P < 0.001). Adding in supine position a lordotic fulcrum on the thoracolumbar junction resulted in a coupled further correction at the thoracic level of 15.7% and lumbar 18.1% (P < 0.001).

Comparing in group A the thoracic and lumbar curvatures in standing position with that on a lordotic fulcrum in supine position revealed a total reduction of 31% and 45.6%, respectively. For the independent group B this reduction in 1 step is 38% and 44.4%, respectively.

Conclusion. Scoliotic deformities are significantly reduced in supine position by a lordotic fulcrum force on the thoracolumbar junction. These findings may have consequences on bracing techniques.

We hypothesized that correction of the scoliosis in patients with idiopathic double major curve scoliosis may benefit from a lordotic fulcrum force in the sagittal plane at the thoracolumbar junction.

From the *Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands; and †Department of Pathology, VUMC, Amsterdam, The Netherlands.

Acknowledgment date: January 9, 2006. First revision date: May 25, 2006. Second revision date: May 24, 2007. Third revision date: July 29, 2007. Fourth revision date: October 9, 2007.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to P.J.M. van Loon, MD, Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.