{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:16:19Z","timestamp":1793297779843,"version":"4.5.0"},"reference-count":22,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T00:00:00Z","timestamp":1699401600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Lower instrumented vertebra (LIV) selection is critical to avoid complications like adding-on. This study aims to determine the usefulness of the traction test (TR) in selecting the LIV during surgery for adolescent idiopathic scoliosis (AIS). We analyzed 42 AIS patients with Lenke 1 curves who had preoperative, postoperative, and at least 12-month follow-up X-rays, as well as preoperative side bending (SB) and TR radiograms. Neutral vertebra (NV), stable vertebra (SV), lower instrumented vertebra (LIV), and Cobb angles were identified and compared on all radiographic images. In 23 cases, the TR resulted in SV proximalization compared to the preoperative X-rays, while in 8 cases, SV-TR was more distal. This distalization occurred in 50% of Lenke 1C curves, where a greater correction of the distal curve was found. NV-TR was proximal to NV-preop in 9 cases, while NV-SB was proximal in 22 cases. LIV was proximal to SV-TR in 8 cases, while it was proximal to SV-preop in 22. One patient with LIV proximal to SV-TR developed adding-on. In conclusion, the TR is crucial in AIS preoperative planning as it provides information distinct from that of standard X-rays and SB: (1) it better assesses gravitational stability than rotational stability; and (2) choosing LIV equal to or proximal to SV-TR may prevent adding-on, except in \u2018flexible\u2019 Lenke 1C curves where LIV should be equal or distal to SV-preop.<\/jats:p>","DOI":"10.3390\/jcm12226986","type":"journal-article","created":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T03:42:40Z","timestamp":1699501360000},"page":"6986","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["What Is the Role of Traction Test Radiographs in the Preoperative Planning of Adolescent Idiopathic Scoliosis?"],"prefix":"10.3390","volume":"12","author":[{"given":"Giovanni Andrea","family":"La Maida","sequence":"first","affiliation":[{"name":"U.O.C. Ortopedia e Traumatologia per le Patologie della Colonna Vertebrale, ASST G. Pini\u2014CTO, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Gallazzi","sequence":"additional","affiliation":[{"name":"U.O.C. Ortopedia e Traumatologia per le Patologie della Colonna Vertebrale, ASST G. Pini\u2014CTO, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Ramella","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Biomediche per la Salute, Universit\u00e0 degli Studi di Milano, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Ferraro","sequence":"additional","affiliation":[{"name":"U.O.C. Ortopedia e Traumatologia per le Patologie della Colonna Vertebrale, ASST G. Pini\u2014CTO, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7957-3551","authenticated-orcid":false,"given":"Andrea","family":"Della Valle","sequence":"additional","affiliation":[{"name":"U.O.C. Ortopedia e Traumatologia per le Patologie della Colonna Vertebrale, ASST G. Pini\u2014CTO, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Cecconi","sequence":"additional","affiliation":[{"name":"U.O.C. Ortopedia e Traumatologia per le Patologie della Colonna Vertebrale, ASST G. Pini\u2014CTO, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo","family":"Misaggi","sequence":"additional","affiliation":[{"name":"U.O.C. Ortopedia e Traumatologia per le Patologie della Colonna Vertebrale, ASST G. Pini\u2014CTO, 20122 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1097\/BRS.0000000000002423","article-title":"Prevalence, Risk Factors, and Characteristics of the \u201cAdding-On\u201d Phenomenon in Idiopathic Scoliosis after Correction Surgery: A Systematic Review and Meta-Analysis","volume":"43","author":"Yang","year":"2018","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1097\/BRS.0b013e3181f51e95","article-title":"Distal adding-on phenomenon in Lenke 1A scoliosis: Risk factor identification and treatment strategy comparison","volume":"36","author":"Wang","year":"2011","journal-title":"Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.jspd.2017.10.002","article-title":"Optimal Lowest Instrumented Vertebra for Thoracic Adolescent Idiopathic Scoliosis","volume":"6","author":"Fischer","year":"2018","journal-title":"Spine Deform."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"E742","DOI":"10.1097\/BRS.0000000000001374","article-title":"Selecting the Last \u201cSubstantially\u201d Touching Vertebra as Lowest Instrumented Vertebra in Lenke Type 1A Curve: Radiographic Outcomes with a Minimum of 2-year Follow-Up","volume":"41","author":"Qin","year":"2016","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1097\/BRS.0000000000001303","article-title":"Adding-on Phenomenon after Surgery in Lenke Type 1, 2 Adolescent Idiopathic Scoliosis: Is it Predictable?","volume":"41","author":"Yang","year":"2016","journal-title":"Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1177\/21925682211015193","article-title":"Combination of Side-Bending and Traction Radiographs Do Not Influence Selection of Fusion Levels Compared to Either One Alone in Adolescent Idiopathic Scoliosis","volume":"13","author":"Arima","year":"2023","journal-title":"Glob. 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