Child Orthopedics

Frequently Asked Questions

In our community, there is a special digitized computer that can be used to measure scoliosis. We have some baseline X-rays already taken of our 11 year-old daughter with this problem. The computerized method costs more. Is it more accurate?

There are many advantages of the updated digitized and computerized technology used to measure scoliosis (curvature of the spine) compared with standard X-rays. In both methods, a measurement called the Cobb angle is determined. The Cobb angle is defined as the angle formed between a line drawn parallel to the superior endplate of one vertebra above the curve and a line drawn parallel to the inferior endplate of the vertebra one level below the curve. Superior means above and inferior refers to below. The endplate is a flat piece of cartilage that comes in direct contact with the disc as it sits in between two vertebrae. Using standard X-rays, the orthopedic surgeon or radiologist uses a special tool called a protractor to calculate the angle. They mark right on the X-ray with special pencils and markers where the top of the curve begins and where the bottom of the curve ends. Sometimes different sized protractors are required and markers of varying widths are used. Anytime tools of this type are used, there's an added element of error possible. These are eliminated with the computerized/digitized programs. The quality of the X-rays can make a difference too. Poor quality pictures can contribute to errors. All of these potential problems don't exist with digitized programs because the computer software allows the examiner to change the sharpness and brightness and enhance the contrast. More consistent measurements are possible with this method.

Satyen S. Mehta, MS, MRCS, et al. Interobserver and Intrabserver Reliability of Cobb Angle Measurement: Endplate Versus Pedicle as Bony Landmarks for Measurement: A Statistical Analysis. In Journal of Pediatric Orthopaedics. October/November 2009. Vol. 29. No. 7. Pp. 749-754.

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