Radiographic Cobb Angle Research Articles

Automatic assessment of scoliosis surgery outcome on trunk shape using left-right trunk asymmetry.

To present a novel set of Left-Right Trunk Asymmetry (LRTA) indices and use them to assess the postoperative appearance of the trunk in Adolescent Idiopathic Scoliosis (AIS) patients. We hypothesize that LRTA measurements provide complementary information to existing trunk asymmetry indices when documenting the outcome of scoliosis surgery. Forty-nine AIS patients with thoracic curves who underwent posterior spinal fusion were included. All had surface topography scans taken preoperatively and at least 6 months postoperatively. We documented spinal curvature using Radiographic Cobb angles, scoliometer readings and coronal balance. To evaluate Global Trunk Asymmetry (GTA), we used the standard measures of Back Surface Rotation (BSR) and Trunk Lateral Shift (TLS). To measure LRTA, we identified asymmetry areas as regions of significant deviation between the left and right sides of the 3D back surface. New parameters called Deformation Rate (DR) and Maximum Asymmetry (MA) were measured in different regions based on the asymmetry areas. We compared the GTA and LRTA changes with those in spinal curvature before and after surgery. The GTA indices, mainly TLS, showed improvement for more than 75% of patients. There was significant improvement of LRTA in the shoulder blades and waist regions (95% and 80% of patients respectively). We report positive outcomes for LRTA in the majority of patients, specifically in the shoulder blades and waist, even when no reduction of BSR is observed. The proposed indices can evaluate local trunk asymmetries and the degree to which they are improved or worsened after scoliosis surgery.

Monitoring of Curve Progression in Patients with Adolescent Idiopathic Scoliosis Using 3-D Ultrasound

ObjectiveTo investigate whether 3D ultrasound can provide comparable results to conventional X-ray examination in assessing curve progression in AIS patients. Methods136 AIS subjects (42 males and 94 females; 10-18 years of age, mean of 14.1 ± 1.9 years) with different severities of scoliosis (Cobb angle ranged from 10-85 degrees, mean of 24.3 ± 14.4 degrees) were included. Each subject underwent bi-planar low-dose X-ray EOS® and 3D ultrasound system scanning with the same posture on the same date. Subjects underwent the second assessment at routine clinical follow-up. Manual measurement of scoliotic curvature on ultrasound coronal projection images and posterior-anterior radiographs were presented as ultrasound curve angle (UCA) and radiographic Cobb angle (RCA), respectively. RCA and UCA increments of five degrees or more represented a scoliosis progression detected by X-ray assessment and 3D ultrasound assessment, respectively. ResultsThe sensitivity and specificity for UCA measurement for detecting scoliosis progression were 0.93 and 0.90, respectively. The negative likelihood ratio of the diagnostic test for scoliosis progression by the 3D ultrasound imaging system was 0.08. ConclusionThe 3D ultrasound imaging method is a valid technique to detect coronal curve progression as compared to conventional radiography in follow-up of AIS. Substituting conventional radiography by 3D ultrasound is effective in reducing the radiation dose to be suffered by AIS patients during their follow-up examinations.

Three-dimensional ultrasonography could be a potential non-ionizing tool to evaluate vertebral rotation of subjects with adolescent idiopathic scoliosis.

Three-dimensional (3D) ultrasonography is nonionizing and has been demonstrated to be a reliable tool for scoliosis assessment, including coronal and sagittal curvatures. It shows a great potential for axial vertebral rotation (AVR) evaluation, yet its validity and reliability need to be further demonstrated. Twenty patients with adolescent idiopathic scoliosis (AIS) (coronal Cobb: 26.6 ± 9.1°) received 3D ultrasound scan for twice, 10 were scanned by the same operator, and the other 10 by different operators. EOS Bi-planar x-rays and 3D scan were conducted on another 29 patients on the same day. Two experienced 3D ultrasonographic researchers, with different experiences on AVR measurement, evaluated the 3D ultrasonographic AVR of the 29 patients (55 curves; coronal Cobb angle: 26.9 ± 11.3°). The gold standard AVR was determined from the 3D reconstruction of coronal and sagittal EOS radiographs. Intra-class correlation coefficients (ICCs), mean absolute difference (MAD), standard error measurements (SEM), and Bland-Altman's bias were reported to evaluate the intra-operator and inter-operator/rater reliabilities of 3D ultrasonography. The reliability of 3D ultrasonographic AVR measurements was further validated using inter-method with that of EOS. ICCs for intra-operator and inter-operator/rater reliability assessment were all greater than 0.95. MAD, SEM, and bias for the 3D ultrasonographic AVRs were no more than 2.2°, 2.0°, and 0.5°, respectively. AVRs between both modalities were strongly correlated (R 2 = 0.901) and not significantly different (p = 0.205). Bland-Altman plot also shows that the bias was less than 1°, with no proportional bias between the difference and mean of expected and radiographic Cobb angles. This study demonstrates that 3D ultrasonography is valid and reliable to evaluate AVR in AIS patients. 3D ultrasonography can be a potential tool for screening and following up subjects with AIS and evaluating the effectiveness of nonsurgical treatments.

Vitamin D and adolescent idiopathic scoliosis, should we stop the hype? A cross-sectional observational prospective study based on a geometric morphometrics approach

PurposeThere is strong evidence supporting the presence of fluctuating asymmetry (FA) in Adolescents with Idiopathic Scoliosis (AIS). Additionally, recent research investigating the relationship between vitamin D and AIS found a relation between them. We hypothesize a negative correlation between FA and vitamin D.MethodsWe performed a surface scan of the torso of 53 AIS patients, a blood test to measure vitamin D and the radiographic Cobb angle. A correlation analysis between vitamin D and FA was carried out to test our hypothesis, and a regression of vitamin D on 3D shape was performed to observe shape differences between the vitamin D deficiency and insufficiency groups.ResultsThere was no correlation between vitamin D and FA. We found a strong negative correlation between vitamin D and the Cobb angle only in the premenarche group (n = 7; r = − 0.92). Differences in shape were observed between the deficiency and insufficiency groups, and that differences were related to the width of the torso, but not the rotation or lateral flexion.ConclusionsOur results do not support the massive screening of vitamin D in AIS. Shape analysis revealed differences between the shape of the deficiency and insufficiency groups related to robustness. However, this finding had no relation with the scoliosis characteristics, it just reflected different body composition, and its importance should be explored in future.

Hyperkyphosis and mortality risk in older men: The osteoporotic fractures in men study.

Hyperkyphosis commonly affects older people but is not widely acknowledged as a clinically actionable problem, especially in men. There are several techniques to quantify kyphosis including the blocks and Cobb angle measurements. This study includes both kyphosis measures to investigate whether older men with accentuated kyphosis may be at increased mortality risk. Men aged ≥65 years (N=5994) were recruited to participate in the MrOS prospective cohort study from 2000 to 2002 (baseline). Our primary cohort included 2931 enrollees (mean age 79.3 years; SD 5.2) who underwent blocks-measured kyphosis from 2006 to 2009. Our secondary cohort included 2351 participants who underwent radiographic Cobb angle measurements at baseline. Cox proportional hazards analyses were used to determine association between kyphosis and all-cause mortality while adjusting for prevalent radiographic vertebral fractures, bone mineral density, incident fractures, gait speed, timed chair stands, self-reported health, alcohol use, medical co-morbidities, and physical activity. During a mean follow-up of 8.3 (SD 3.2) years, 1393 participants died in the primary cohort. In this group, compared to men with 0-1 block kyphosis, increasing blocks-measured kyphosis was associated with increased mortality (HR: 1.26-1.53, p trend <0.001). With addition of prevalent vertebral fracture to adjusted models, the association remained significant in participants with severe kyphosis (3+ blocks-measured). Similarly, with addition of chair stand performance the association remained significant for 4+ blocks kyphosis. Walking speed did not attenuate the association of kyphosis and mortality. In the secondary cohort, there were no significant associations between radiographic Cobb angle kyphosis and mortality. Increasing blocks-measured kyphosis was associated with a greater risk of mortality in older men, indicating that hyperkyphosis identified on physical exam should be considered a clinically significant finding that may warrant further evaluation and treatment.

The deformity angular ratio: can three-dimensional computed tomography improve prediction of intraoperative neuromonitoring events?

Assess whether a novel deformity angular ratio (DAR) calculated using preoperative three-dimensional computed tomography (3D CT) is more accurate than total DAR (T-DAR) radiographic measurements at predicting intraoperative neuromonitoring (IONM) events during vertebral column resection (VCR). Consecutive, unique patients undergoing thoracic VCR by a single surgeon from 2015 to 2021 were identified. The T-DAR was calculated by dividing the total radiographic Cobb angle by the number of vertebral segments the angle subtends. 3D CT DAR was calculated for each patient from a preoperative CT scan by finding the maximum angle subtended by three contiguous vertebral segments. All patients were assessed for IONM events. A binary threshold of 25 was used for T-DAR and 3D CT DAR measurements for predictive analysis. p < 0.05 indicated significance. In total, 68 patients were identified. Mean age was 28years. Mean levels fused was 15. Twenty-one patients (31%) had IONM events. In patients, with and without an IONM event, mean T-DAR was 26.6 ± 9.8 and 21.5 ± 8.8 (p = 0.04), respectively. 3D CT DAR mean values were 26.4 ± 10.8 and 18.4 ± 5.6, respectively (p < 0.001). 3D CT DAR accurately classified 81% of patients with a positive predictive value (PPV) of 75%. In comparison, T-DAR accurately classified 60% of patients with a PPV of 39%. 3D CT substantially improves preoperative IONM event prediction when compared to traditional radiographic measurements. A 3D CT DAR of 25 or greater was correlated with an increased rate of IONM events. 3D CT reconstructions are a useful adjunct for planning prior to a VCR.

TLSO: The Effect of Spinal Translation on Initial Coronal Curve Correction, Lateral Trunk Shift, and Coronal Balance in Adolescent Idiopathic Scoliosis

ABSTRACT Introduction Adolescent idiopathic scoliosis is often treated orthotically with thoracic lumbar sacral orthoses (TLSOs). The goal of these TLSOs is to improve the scoliotic curve during wear to prevent further curve progression. To achieve this in-orthosis curve improvement, clinicians often apply corrective modifications to a 3D model of the patient's trunk through computer-aided design (CAD) software, which are fabricated into the TLSO. Modifications often include laterally shifting certain portions of the orthosis to apply corrective forces to the scoliotic curve. The amount and magnitude of the shifting applied are loosely based on clinical experience and patient characteristics, but the decision is somewhat arbitrary. The purpose of this study is to determine any existing correlation between applied coronal translation (shift) through CAD modifications of TLSOs and resulting coronal curve correction in female subjects with idiopathic scoliosis. Materials and Methods Female subjects with idiopathic scoliosis who were prescribed a TLSO were included in this study. Demographic and clinical data were collected from medical records on age, sex, hours of TLSO wear, body mass index (BMI), and Risser sign. Radiographic Cobb angle, data regarding curve flexibility, and the amount of coronal translation used during the CAD modification process were recorded. Differences in the primary scoliotic curve were then assessed based on initial x-rays and in-orthosis x-rays to calculate the change in Cobb angle, apical vertebra translation (AVT), coronal balance (CB), and thoracic trunk shift (TTS). Results Seventeen participants were included in the study. Average measured curve flexibility was 59.64%, and applied coronal translation to the CAD model ranged from 3 to 19 mm. Average Cobb angle improvement from the initial x-ray to the first in-orthosis x-ray was 23.57%, which was statistically significant (P &lt; 0.01). Average improvement of AVT was 6.52 mm, which was statistically significant (P &lt; 0.05). CB improved by an average of 5.29 mm, and TTS improved by an average of 2.33 mm, neither of which was found to be a statistically significant improvement. No correlation was found between applied shifting in CAD modifications and Cobb angle improvement, AVT improvement, CB improvement, or TTS improvement. Conclusions These results do not support the hypothesis that greater applied lateral shifting in TLSO CAD modifications leads to greater coronal scoliotic curve correction. Orthotists are not able to predict in-orthosis coronal curve correction based on CAD modifications, spinal flexibility, and BMI alone. Additional factors play a role in the complexity of AIS treatment.

Comparison between radiographic and ultrasound angle measurements in the assessment of idiopathic scoliosis

&amp;lt;p&amp;gt;Introduction. Radiological assessment is still being considered a golden standard when it comes to detection, follow-up and treatment of idiopathic scoliosis. However, it has universally been proven that radiation is cumulative and that it has oncogenic effects. For this reason, nowadays it is becoming increasingly popular to perform spinal ultrasounds using the Scolioscan&amp;amp;reg; device. Relevant research has shown diagnostic potential of the device and its application in the assessment and monitoring of idiopathic scoliosis. The aim of our study has been to compare angle measurements in ultrasound and radiological spinal images and to determine the role of ultrasound in the assessment process and follow-up of patients with idiopathic scoliosis. Methods. This cross-sectional study has been conducted on a sample of 172 patients. Its participants are boys and girls, patients of the Team for Scoliosis that operates within the Department for Habilitation and Rehabilitation of Children in the Institute for Physical Medicine and Rehabilitation ''Dr Miroslav Zotović'', Banja Luka, the Republic of Srpska. Radiography and ultrasound of the spine have been performed on every patient on the same day. Three specially trained operators administrated the ultrasound scanning, while four raters (i.e. doctors) measured the radiographic Cobb angle and the ultrasound Scolio angle. Patients have been divided into groups according to gender, curve location and curve severity. Results. In general, ultrasound angles are shown to be smaller compared to Cobb angles, which has been confirmed in previous studies as well. The mean difference between Cobb and Scolio angle is statistically, but not clinically significant (3.62&amp;amp;plusmn;4.39&amp;amp;deg;, p&amp;amp;lt;0.001). There is a statistically significant good positive correlation between the Cobb and the Scolio angle (r=0.675, p&amp;amp;lt;0.001). According to groups, our results indicate a better correlation in the girls group (r=0.688, p&amp;amp;lt;0.001) as opposed to the boys group (r=0.632, p&amp;amp;lt;0.001). The same holds true for the thoracic group (r=0.736, p&amp;amp;lt;0.001), compared to the (thoraco) lumbar group (r=0.654, p&amp;amp;lt;0,001). A stronger correlation can also be seen in the group with a Cobb angle that is equal to or higher than 20&amp;amp;deg; (r=0.518, p&amp;amp;lt;0.05) than in the group with a Cobb angle lower than 20&amp;amp;deg; (r=0.462, p&amp;amp;lt;0.001). Conclusion. The results of our study confirmed a good validity of the ultrasound method using the Scolioscan&amp;amp;reg; device, compared to conventional radiography, taking into account clinically insignificant differences in angle measurements. Using only B-mode ultrasound images - with no additional software analysis, nor 3D reconstruction of spinal deformities - proved to be sufficient for a follow-up of scoliosis, with respect to other parameters, such as clinical assessment, back surface topography, etc.&amp;lt;/p&amp;gt;

Moiré topography as a screening and diagnostic tool-A systematic review.

Diagnostic investigation can be carried out using non-radiological and non-contact methods. Moiré topography (MT) seems to be a viable alternative to radiographic research in evaluating the spine and/or trunk deviations. The aim of this systematic review was to analyze the current knowledge regarding the reliability and validity of Moiré topography as a screening and diagnostic tool. The systematic review was performed from 2010 until March 2021 in the PubMed, EBSCO, Web of Science, and Scopus databases, according to the eligibility criteria. This review fulfilled the following criteria according to the PICO system: population (children and adolescents), intervention (MT measurement), comparison (repeated MT measurements, MT compared to Cobb angle or scoliometer), outcome (reliability and validity of MT). Eight studies fulfilled the inclusion criteria for further analysis. All the studies were assessed to be of high quality. Included studies found that MT had high repeatability and high intraobserver and interobserver correlation, and correlation between MT parameters and radiographic Cobb angle ranged from moderate to high. The authors reported difficulty in defining the cut-off values for MT parameter (Surface Trunk Rotation—STR), and unsatisfactory sensitivity and specificity of MT examination. The studies did not reveal the advantage of MT as a screening method in the detection of idiopathic scoliosis in comparison to radiograph. Based on the evidence from eight studies, the results indicated moderate evidence for reliability and validity of Moiré topography as a screening and diagnostic tool. There is still no strong evidence for the accuracy of MT.

3D ultrasound imaging provides reliable angle measurement with validity comparable to X-ray in patients with adolescent idiopathic scoliosis.

Background & ObjectiveThe application of ultrasound imaging for spine evaluation could minimize radiation exposure for patients with adolescence idiopathic scoliosis (AIS). A customized three-dimensional (3D) ultrasound imaging system has been demonstrated to provide reliable and valid coronal curvature measurements. However, these measurements were using the spinous processes as anatomical reference, leading to a predictable underestimation of the traditionally used Cobb angles. An alternative 3D ultrasound image reconstruction method was applied to create coronal images with more lateral features for angle measurement. The objective of this study was to test the reliability and the validity of this angle, the ultrasound curve angle (UCA), and compare the UCA with the Cobb angles on X-ray images of patients with AIS.Materials and methodsThis study was divided into: 1) Investigation of intra- and inter-reliability between two raters for measuring the UCA and two operators for acquiring ultrasound images; 2) Investigation of the validity between the radiographic Cobb angle and the UCA. Fifty patients and 164 patients with AIS, were included in the two stages, respectively. Patients underwent bi-planar X-ray and 3D ultrasound scanning on the same day. The proposed UCA was used to measure the coronal curvature from the ultrasound coronal images, which were formed using a newly customized volume projection imaging (VPI) method. The intra-rater/operator and inter-rater and operator reliability of the UCA were tested by intra-class correlation coefficient (ICC) (3,1) and (2,1), respectively. The validity of UCA measurements as compared to radiographic Cobb angles was tested by inter-method ICC (2,1), mean absolute difference (MAD), standard error of measurement (SEM), Pearson correlation coefficient and Bland–Altman statistics. The level of significance was set as 0.05.ResultsExcellent intra-rater and intra-operator (ICC (3,1)≥0.973) and excellent inter-rater and inter-operator reliability (ICC (2,1)≥0.925) for UCA measurement, with overall MAD and SEM no more than 3.5° and 1.7° were demonstrated for both main thoracic and (thoraco)lumbar curvatures. Very good correlations were observed between UCA and Cobb angle for main thoracic (=0.893) and (thoraco)lumbar (=0.884) curves. The mean (SD) measurements in terms of radiographic Cobb and UCA were 27.2 ​± ​11.6° and 26.3 ​± ​11.4° for main thoracic curves; and 26.2 ​± ​11.4° and 24.8 ​± ​9.7° for (thoraco)lumbar curve respectively. One hundred sixty-four subjects (33 male and 131 female subjects; 11–18 years of age, mean of 15.1 ​± ​1.9 years) were included for the validity session. Excellent inter-method variations (ICC (2,K) ≥0.933) with overall MAD and SEM no more than 3.0° and 1.5° were demonstrated for both main thoracic and (thoraco)lumbar curvatures. In addition, Bland–Altman plots demonstrated an acceptable agreement between ultrasound and radiographic Cobb measurements.ConclusionIn this study, very good correlations and agreement were demonstrated between the ultrasound and X-ray measurements of the scoliotic curvature. Judging from the promising results of this study, patients with AIS with different severity of curves can be evaluated and monitored by ultrasound imaging, reducing the usage of radiation during follow-ups. This method could also be used for scoliosis screening.The Translational potential of this article: Ultrasound curve angle (UCA) obtained from 3D ultrasound imaging system can provide reliable and valid evaluation on coronal curvature for patients with AIS, without the need of radiation.

Late spinal infections following posterior spinal fusion in pediatric deformities: treatment using single-stage titanium implant exchange.

Late infection following posterior spinal fusion (PSF) for deformity is a leading cause of revision. The purpose of this study is to evaluate clinical and radiographic outcomes following a single-stage debridement and exchange of spinal implants with titanium in adolescent patients with late-onset infections following PSF METHODS: A retrospective review of prospectively collected data of adolescent patients with spinal deformity, who were surgically treated with PSF was collected. Patients were included for the study if they developed late arising infection (> 1year after index posterior fusion for the deformity) from 2006-2019. Treatment consisted of irrigation, debridement, implant exchange with titanium screws and rods, and antibiotics. Parameters evaluated include radiographic Cobb angles, operative data, and clinical data, all at minimum 2-year follow-up. 31 patients (29 with AIS and 2 with Scheuermann's kyphosis) developed late spinal infections. Mean age was 11.4 ± 2.3years, 84% female, mean time from index surgery was 52.5months. 25 had all stainless steel implants and 6 had cobalt chrome during the index procedure. Positive cultures were obtained in 5 patients (2 Staphylococcus Aureus, 1 Staphylococcus epidermidis, 1 Peptostreptococcus, 1 Pseudomonas aeruginosa) with cultures followed till 7days post-operatively. At 2-years following the exchange, there was no change in coronal and sagittal alignment. Three (9%) patients developed subsequent infection necessitating implant removal. A single-stage procedure consisting of implant removal, irrigation, and debridement, and replacement with all titanium implants is an effective treatment strategy in patients developing late wound infection following PSF with regards to maintenance of curve correction and minimizing recurrent infections.

Cross-validation of ultrasound imaging in adolescent idiopathic scoliosis

PurposeAdolescent idiopathic scoliosis (AIS) patients are exposed to 9–10 times more radiation and a fivefold increased lifetime cancer risk. Radiation-free imaging alternatives are needed. Ultrasound imaging of spinal curvature was shown to be accurate, however, systematically underestimating the Cobb angle. The purpose of this study is to create and cross-validate an equation that calculates the expected Cobb angle using ultrasound spinal measurements of AIS patients.MethodsSeventy AIS patients with upright radiography and spinal ultrasound were split randomly in a 4:1 ratio to the equation creation (n = 54) or validation (n = 16) group. Ultrasound angles based on the spinous processes shadows were measured automatically by the ultrasound system (Scolioscan, Telefield, Hong Kong). For thoracic and lumbar curves separately, the equation: expected Cobb angle = regression coefficient × ultrasound angle, was created and subsequently cross-validated in the validation group.ResultsLinear regression analysis between ultrasound angles and radiographic Cobb angles (thoracic: R2 = 0.968, lumbar: R2 = 0.923, p < 0.001) in the creation group resulted in the equations: thoracic Cobb angle = 1.43 × ultrasound angle and lumbar Cobb angle = 1.23 × ultrasound angle. With these equations, expected Cobb angles in the validation group were calculated and showed an excellent correlation with the radiographic Cobb angles (thoracic: R2 = 0.959, lumbar: R2 = 0.936, p < 0.001). The mean absolute differences were 6.5°–7.3°. Bland–Altman plots showed good accuracy and no proportional bias.ConclusionThe equations from ultrasound measurements to Cobb angles were valid and accurate. This supports the implementation of ultrasound imaging, possibly leading to less frequent radiography and reducing ionizing radiation in AIS patients.

Comparison of Cobb Angles on Radiographs With Magnetic Resonance Imaging in Idiopathic Scoliosis

Background: Patients with idiopathic scoliosis are exposed to repetitive x-ray for angle measurement. Therefore, the discovery or development of alternative techniques with less radiation has continuously been a major concern. Objectives: In this study, we compared the Cobb angles on supine Magnetic Resonance Imaging (MRI) with those on standing plain radiographs to figure out how precisely the supine MRI can show the real curve. Consequently, the need for certain exposures throughout the management of idiopathic scoliosis might be eliminated. Methods: A total of 103 patients with idiopathic scoliosis were included in this prospective study. The standing radiographs and supine MRI were obtained with less than a 1-month time lag. One senior author assessed Cobb angles of the major curves were on both standing radiographs and MR images. All the eligible patients had already signed the consent for diagnostic imaging, including MRI. The individuals, who were not requested for x-ray and MRI, were excluded from this study. Results: The Mean±SD Cobb angle was 55.5±11.2°‎‏ on the standing plain radiographs and 44.5±10°‎‏ on MR images (P&lt;0.001). The Mean±SD difference between the Cobb angles on the standing plain radiographs and MR images was 11±1.4°‎‏. A significant positive correlation was found between the Cobb angles calculated on plain radiographs and MRI (r=0.996, P&lt;0.001). Accordingly, Cobb angles on MRI could be converted to Cobb angles on plain radiographs under the formula of MRI=0.9* XRAY-5.31 (absolute error of 5.31°‎‏). Conclusion: Cobb angles on supine MRI correlates with measured ones on standing radiographs with an acceptable range of error and could be used as a valuable alternative for radiographic Cobb angle measurement.

Reliability and validity of non-radiological measures of thoracic kyphosis in chronic obstructive pulmonary disease

Background/Aims: Thoracic kyphosis in people with chronic obstructive pulmonary disease can be measured from digital photogrammetry or three-dimensional motion capture. This study aimed to determine the reliability, validity and agreement for non-radiological measures of thoracic kyphosis in chronic obstructive pulmonary disease. Methods: A total of 19 participants with chronic obstructive pulmonary disease were included. Cobb angles from chest radiographs and spinous process landmarks using photogrammetry and three-dimensional motion capture were evaluated. Findings: The mean kyphosis (± standard deviation) was 48.8 ± 10.9 degrees by radiograph; 49.6 ± 12.9 degrees by three-dimensional motion capture and 52.2 ± 11.1 degrees by photogrammetry. Radiographic Cobb angle and photogrammetry measurements demonstrated excellent intra- and inter-rater reliability. Correlation between non-radiological kyphosis measurements and chest radiographs was strong (Pearson's r2 &gt;0.75 for both). Limits of agreement between radiographs and 3D motion capture were –9 degrees to 7 degrees, and –12 to 8 degrees between radiographs and photogrammetry. Conclusions: Non-radiological measures of thoracic kyphosis are reliable and valid in chronic obstructive pulmonary disease.

Radiographic Cobb Angle: A Feature of Congenital Lumbar Spine Stenosis

Purpose: A low cost, reproducible radiographic method of diagnosing congenital lumbar spinal stenosis (CLSS) is lacking. We hypothesized that the Cobb angle for lumbar lordosis would be smaller in patients with CLSS, based on observations in our spine clinic patient population. Here, we compared lumbar lordosis Cobb angles with the radiographic ratio method in patients with normal spine imaging, degenerative spinal stenosis, and with CLSS. Materials and MethodsOrthopedic surgeons categorized patients with low back pain as “Normal,” “Degenerative spinal stenosis,” and “CLSS” based on clinical presentation and findings on lumbar magnetic resonance imaging. We included 30 patients from each cohort who had undergone lateral lumbar spine radiographs and lumbar magnetic resonance imaging. For each lateral radiograph, 2 measurement methods were used (1) 4-line lumbosacral Cobb angle between L2-S1 and (2) the ratio of the anteroposterior vertebral body diameter and spinal canal anteroposterior diameter at the L3 level. We performed logistic regression analyses of CLSS prediction by Cobb angle vs the ratio method in all three cohorts. Covariates included age, gender, and body mass index. ResultsThe radiographic Cobb angles were smaller in CLSS patients when compared to the degenerative disease and normal cohorts: a smaller radiographic Cobb angle showed higher odds ratio (OR) of predicting CLSS diagnosis compared to the radiographic ratio when compared with degenerative disease (OR = 0.28; 95% CI: 0.11-0.78, P = 0.01) and when compared with the normal cohort (OR = 0.46; 95% CI: 0.24-0.92, P = 0.03). Radiographic ratio measurements showed no difference between the three cohorts (P = 0.12). CLSS was associated with male gender (P = 0.04), younger age (P = 0.01), and higher body mass index (P = 0.01). ConclusionThe radiographic Cobb angle method for lumbar lordosis may be useful for raising the possibility of CLSS as the diagnosis.

The impact of curve severity on obstetric complications and regional anesthesia utilization in pregnant patients with adolescent idiopathic scoliosis: a preliminary analysis.

OBJECTIVE Adolescent idiopathic scoliosis (AIS), the most common type of scoliosis, often presents immediately prior to a woman's childbearing years; however, research investigating the impact of AIS on women's health, particularly pregnancy delivery outcomes, is sparse, with existing literature reporting mixed findings. Similarly limited are studies examining the change in scoliotic curve during or after pregnancy. Therefore, this study aims to determine 1) the impact of scoliotic curvature on obstetric complications (preterm births, induction of labor, and urgent/emergency caesarean section delivery), 2) regional anesthetic decision making and success during delivery for these patients, and 3) the effect of pregnancy on curve progression. METHODS Records of all pregnant patients diagnosed with AIS at the authors' institution who delivered between January 2002 and September 2016 were retrospectively reviewed. Demographic information, pre- and postpartum radiographic Cobb angles, and clinical data for each pregnancy and delivery were recorded and analyzed. The Wilcoxon rank-sum test and the Wilcoxon signed-rank test were used for statistical analyses. RESULTS Fifty-nine patients (84 deliveries) were included; 14 patients had undergone prior posterior spinal fusion. The median age at AIS diagnosis was 15.2 years, and the median age at delivery was 21.8 years. Overall, the median major Cobb angle prior to the first pregnancy was 25° (IQR 15°-40°). Most births were by spontaneous vaginal delivery (n = 45; 54%); elective caesarean section was performed in 17 deliveries (20%). Obstetric complications included preterm birth (n = 18; 21.4%), induction of labor (n = 20; 23.8%), and urgent/emergency caesarean section (n = 12; 14.0%); none were associated with severity of scoliosis curve or prior spinal fusion. Attempts at spinal anesthesia were successful 99% of the time (70/71 deliveries), even among the patients who had undergone prior spinal fusion (n = 13). There were only 3 instances of provider refusal to administer spinal anesthesia. In the subset of 11 patients who underwent postpartum scoliosis radiography, there was no statistically significant change in curve magnitude either during or immediately after pregnancy. CONCLUSIONS The results of this study suggest that there was no effect of the severity of scoliosis on delivery complications or regional anesthetic decision making in pregnant patients with AIS. Moreover, scoliosis was not observed to progress significantly during or immediately after pregnancy. Larger prospective studies are needed to further investigate these outcomes, the findings of which can guide the prenatal education and counseling of pregnant patients with AIS.

Validity and Reliability of Spine Raster-stereography in Adolescent Idiopathic Scoliosis Patients

Introduction Previous studies have evaluated the validity and reliability of the Formetric-4D system. They concluded to a good accuracy compared with radiographs and a high intra- and inter-day reliability in healthy volunteer patients. However, to the best of our knowledge, the validity and reliability were not assessed on patients with Adolescent Idiopathic Scoliosis (AIS). Therefore, the aim of this study was to evaluate the validity and reliability of the Formetric 4D system on AIS adolescent patients with Cobb between 10¡ and 40¡ in terms of sagittal, frontal and transverse parameters. Materials and Methods This study included 35 AIS adolescents (male=13) aged 13.1 ± 2.0 years. To evaluate the validity of scoliosis angle (SA) provided by the Formetric-4D System, a comparison was performed with the Cobb Angle of major curve (CA) on a 2D EOS¨ radiography (XR). Mean differences of measurements computed by each system were evaluated using paired Student t-test and Pearson correlation coefficient. To evaluate interrater reliability three repeated-measurements were independently performed in a neutral orthostatic position using the Formetric-4D System by two operators the same day. To evaluate the intrarater reliability three more repeated-measurements were performed by the first operator one week later. The parameters measured were vertebra surface rotation, thoracic kyphosis, lumbar lordosis, pelvic obliquity, trunk length and the scoliosis angle. The data analyses used were Intraclasse Correlation Coefficients (ICC). Results The 2D radiographic Cobb Angle (CA) and its rasterstereographic equivalent Scoliosis Angle (SA) were strongly correlated (R = 0,70) with a non-significant difference. The ICC for intrarater (same day: ICC (1, 1), n = 35, one week later: ICC (1, 3), n = 29) as interrater reliability coefficients (ICC (3, 3), n = 16) were excellent (ICC &gt; 0.75) for all variables except for pelvic obliquity with the highest for sagittal and rotation parameters and lowest for the pelvis obliquity. Conclusion This study showed that the Formetric 4D system allows evaluating AIS patients with a good validity and an overall excellent intra- and interrater reliability. Based on these results, this automatic, fast and non-invasive system will not replace XR clinical analysis but it can reduce the exposure to radiation for the patients and can improve the monitoring of scoliosis evolution with no limits of use, no risks for patients and at lower price than XR.

Radiographic, Pain, and Functional Outcomes in an Adult Post-Fusion Patient Using a Scoliosis Activity Suit: Comparative Results after 8 Months

There are few conservative treatment options for adult patients with idiopathic scoliosis who are status post-fusion surgery. These typically include pharmacologic pain management, epidural injections, and generalized CAM treatments such as massage and chiropractic manipulation in the non-fused areas of the spine. The purpose of this study was to compare the post-treatment results in an adult post-fusion patient who wore a scoliosis activity suit for 8 months. Pain was evaluated using a quadruple visual analog scale (QVAS), while function was measured using an SRS-22r questionnaire. After 8 months of wearing the scoliosis activity suit, her pain scores improved, here SRS-22r improved, and a significant correction in radiographic Cobb angle was observed. This case report is the first to document a Cobb angle change in an adult patient wearing a scoliosis activity suit who is status post-fusion. Given that pain and dysfunction are primary reasons for scoliosis treatment in the adult population, more studies need to address the disparity between available treatments for adult scoliosis and the incidence of adult scoliosis, especially in the post-meno-pausal population. Future prospective studies should consider evaluating treatment effects of this suit using intent-to-treat methodology.

Changes in Urinary Bone Resorption Marker after Taking a Combination Nutrient Formula in Adults with Scoliosis: A Retrospective, Open-Label, Case-Controlled Series

Background: Scoliosis is a common condition in adult patients, and often causes chronic back pain compared to non-scoliosis. It has also been identified that bone mineral density is very often compromised in patients with scoliosis, even occurring in adolescence. At this time, no study has looked at how bone mineral density and scoliosis incidence or severity may be connected with specific regard to treatment. This study presents data on the outcomes of a scoliosis-specific exercise therapy and its ability to correct scoliotic curvatures in adult patients alone and in combination with bone mineral density supplementation. Methods: The charts of 14 total patients were retrospectively selected based upon specific inclusion criteria. Outcome assessments included the radiographic Cobb angle of the primary curvature, as well as laboratory measures of urinary deoxypyridinoline cross links. These results were compared against 12 patients who did not take the bone density supplement during or after their exercise-based treatment. Results: Patients taking the bone density supplement achieved the same level of Cobb angle reduction as compared to the control group. However, they additionally achieved a significant reduction in urinary deoxypyridinoline cross links as compared to the control group at 6 months. Conclusion: Patients taking a multi-ingredient bone density supplement daily for 6 months after completing a scoliosis-specific exercise program reported statistically significant improvements in urinary deoxypyridinoline cross links as compared to controls. It is unknown if or how bone density loss may contribute to the onset or progression of scoliosis. Long-term follow-up of these patients will be ongoing to assess bone mineral density status and Cobb angle changes longitudinally.

Lung Function Can Be Compromised by Severe Scoliosis

Severe idiopathic scoliosis (radiographic Cobb angle ≥40 degrees) is known to be associated with restrictive lung disease (RLD; low lung volume), but