Radiological assessment of spinal range of motion after selective thoracic scoliosis correction using rigid and dynamic systems

Objective. To perform comparative analysis of postural and functional radiographs of patients after correction of thoracic scoliosis using dynamic versus rigid fixation systems.

Material and Methods. This retrospective study included 105 patients (mean age 27 years) with idiopathic thoracic scoliosis (Lenke type 1). Selective fixation was performed using an anterior dynamic or posterior rigid system. Standard and functional radiographs
(lateral flexion, flexion/extension) were compared two years after surgery.

Results. Both techniques ensured correction of the main curve by 73–75% and the lumbar counter-curve by 62–64% (p ≤ 0.005). In the dynamic fixation group, 92% of sagittal functional range of motion (17.1° out of 17.6°) and 51.4% of coronal range of motion (22.1° out of 39,0°) were preserved in the instrumented area (p ≤ 0.005). Asymmetry was observed: 88.6% (19.6° out of 20.1°) of motion was preserved when bending toward the convex side, versus 27% (35.2° out of 42.1°) when bending toward the concave side. In the rigid fixation group, no motion remained in the fusion area. The total functional range of motion of the entire spine was higher with dynamic fixation than with rigid fixation: in the coronal plane 71.2° vs. 45.1° and in the sagittal plane 78.7° vs. 58.6° (p ≤ 0.005).

Conclusion. The dynamic fixation system provides stable deformity correction comparable to a rigid one but allows preserving up to 92% of sagittal and 51% of coronal mobility in the operated area with characteristic asymmetry. Rigid fixation leads to a complete motion loss in the fusion area and significantly lower total functional range of motion of the spine.

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