Clinical photography has proven to be reliable for posture assessment in adolescents and young adults with idiopathic scoliosis. This paper attempts to elucidate whether clinical photography is capable of distinguishing the distinctive characteristics in trunk deformity of the different Lenke patterns in patients with severe scoliosis candidate for surgery. One hundred and seventy-three patients (82% women), average age of 20.8years and average largest curve magnitude of 58.7° were included. PA standing full-spine X-rays and digital photographs from the back of the trunk were measured. It is used to measure magnitude of the proximal thoracic (PTC), main thoracic (MTC) and thoracolumbar/lumbar (TL/LC) curves, T1 tilt and the clavicle-rib intersection angle. It is used to measure shoulder height angle, axilla height angle, waist height angle (WHA), right and left waist angles and trunk areas. One-way ANOVA to test mean differences among Lenke types for radiological and photographic measurements was performed. ROC curve analysis was conducted to find out cutoff values in photographic measurements to differentiate among curve patterns. Most radiological and photographic measurements differ among curve patterns. On ROC curve analysis, solid cutoff values were found for WHA (AUC = 0.8), left waist angle (AUC = 0.81), right waist angle (AUC = 0.81) and the difference between left and right waist angles (AUC = 0.86) to differentiate between types 1 and 2 and the other three types (3, 5 and 6). Clinical photography is a valid method for assessing trunk asymmetry in severe idiopathic scoliosis. Specifically, for waist area measurements, robust cutoff values can be determined to discriminate among different curve patterns according to Lenke classification. These slides can be retrieved under Electronic Supplementary Material.

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