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Chiropractic Research Review

Cobb Angle vs. Surface Topography in Measuring Scoliosis

The Cobb angle is the gold standard for the monitoring of scoliosis, however it tells more about the severity of the spinal curve than it gives a more global clinical picture of the shape of the back.

Surface topography, a computerized photography system, offers the possibility of describing spinal deformity more fully than radiographic measures alone. To be useful, it must ignore changes due to the varying posture and reliably detect differences that are clinically significant.

This study was designed to determine whether surface topography would reflect Cobb angle status with sufficient reliability to permit its safe use as an alternative means of documentation in some circumstances. Alternatives to the Cobb methods may be useful in the multiple follow up evaluations of patients with scoliosis to limit patient exposure to ionizing radiation, which occurs when radiographs are taken to track the progression of scoliosis using the Cobb method.

Surface topography using Quantec Image Processing was obtained routinely in all patients attending a spinal deformity unit. Inner subject variation was reduced by taking the mean for each parameter of four repositioned scans, which gives a smallest detectable change on almost all measures. Fifty-nine patients with two sets of radiographs and topography scans were studied to determine the ability of the different measurements to detect significant change. There was a significant correlation between the surface topography and Cobb measurements.

Conclusion: It is unlikely that topography will replace radiography in the evaluation of Cobb angles because the margins of error margins associated with each are wide. Additionally, these two measuring systems do not measure the same aspect of deformity. The Quantec system is useful in patient monitoring as an alternative to radiography, without diminishing the standard of care.

Goldberg CJ, Kaliszer M, Moore DP, et al. Surface topography, Cobb angles, and cosmetic changes in scoliosis. Spine 2001:26(4), pp. E55-E63.

Chiropractic Research Review

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