Evidence map›Paper›PMID 40108038›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2025

Flexibility radiographs in pediatric spine surgery are often used but lack consistency.

Hirofumi Kusumoto, Tyler A Tetreault, Michael J Heffernan, Paul D Sponseller, Kenneth M C Cheung, Jaime A Gomez, Steven W Hwang, Purnendu Gupta, Pediatric Spine Study Group, Lindsay M Andras

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Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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No citing paper in PubMed yet.

4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Hirofumi KusumotoDepartment of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA. hkusumoto@dhs.lacounty.gov.
Tyler A TetreaultJackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Michael J HeffernanJackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Paul D SponsellerDepartment of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
Kenneth M C CheungDepartment of Orthopaedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China.
Jaime A GomezDivision of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA.
Steven W HwangShriners Hospitals for Children, Philadelphia, Philadelphia, PA, USA.
Purnendu GuptaShriners Hospitals for Children, Chicago, IL, USA.
Pediatric Spine Study Group
Lindsay M AndrasJackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.ORCID 0000-0002-3390-7878

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeDespite agreement on the importance of spinal curvature flexibility in surgical decision making, there is no consensus regarding optimal radiographic assessment and how this impacts care. We sought to further understand traction film indications and techniques.

methodsA nine-question survey was administered to 194 members of the Pediatric Spine Study Group (PSSG). The survey aimed to elucidate flexibility radiograph practices of pediatric spine surgeons and how these results inform operative plans and timing.

resultsNinety-six of 194 (49.5%) respondents were included in the analysis. 96.9% (93/96) performed radiographic assessment of curve flexibility. Amongst these surgeons, roughly half (52.7%, 49/93) do so for surgical planning only (level selection, osteotomies, construct type, etc.), while 45.2% use them for both surgical planning and surgical timing. Radiographs performed included: supine traction (68.8%, 64/93), supine bending (61.3%, 57/93), standing bending (39.8%, 37/93), supine without traction (20.4%, 19/93), and other (21.5%, 20/93). Supine traction films were typically performed by one person holding the legs and one pulling the arms (62.5%, 40/64) or pulling the chin or head (23.4%, 15/64). Traction is routinely applied by physicians (48.4%, 45/93), radiology technicians (39.8%, 37/93), and physician assistants (20.4%, 19/93). Nearly half (45.2%, 45/93) of surgeons feel that traction films are not a consistent or reproducible measure within their department, and 68.8% (64/93) feel that these films are not reproducible across institutions.

conclusionThe marked variability observed amongst institutional practices and concerns about reproducibility within and across departments warrant the development of a more standardized method to assess curve flexibility.

Indexed as

Orthopedic SurgeonsPediatricsRadiographyScoliosisSpineAdolescentAdultClinical Decision-MakingFemaleHumansMaleMiddle AgedObserver VariationPatient Care PlanningPatient PositioningRange of Motion, ArticularFlexibilityIdiopathic scoliosisNeuromuscular scoliosisPediatric spine surgeryScoliosisTraction films

Identifiers

PMID40108038

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.