Objective: The study was conducted on the possibility of predicting the final outcome of bracing for idiopathic scoliosis at a follow-up period of 6 months.  Methods: In a retrospective study, 62 adolescent female patients with right thoracic scoliosis (20–40° Cobb angle) treated with a brace were examined. A new compliance score was developed. The sample was divided into four groups based on compliance (compliance score) and initial correction (half-year after start bracing): group A, good compliance/high initial correction; group B, good compliance/low initial correction; group C, bad compliance/high initial correction; group D, bad compliance/low initial correction. The final outcome (1 year after weaning) was defined as successful if a curve correction of at least 5° was achieved. The influence of factors on final outcome was analysed by ANOVA. Differences between continuous data were analysed by a two-sample Wilcoxon test. Results: The overall final outcome was not successful (thoracic curve −3°). Ho...

Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up

Study design Preliminary analysis of the clinical value of surface topography in a spinal deformity clinic. Objectives The Cobb angle is the gold standard for the monitoring of scoliosis. 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. Summary of background data Surface topography offers the possibility of describing spinal deformity more fully than radiographic measures alone. To be useful, it must ignore changes due to varying posture and reliably detect differences that are clinically significant, while broadening the ability to assess deformity. Methods Surface topography using Quantec () was obtained routinely in all patients attending a spinal deformity unit. Intrasubject variation was reduced by taking the mean for each parameter of four repositioned scans, which gives a smallest detectable change on all measures of approximately 10 U. 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. Results There was a significant correlation between Cobb angle and Quantec spinal angle. A significant change in Cobb angle could be identified by associated change in at least one topographic measure in a significant proportion of cases. Conclusions It is unlikely that topography will supplant radiography for the ascertainment of Cobb angles, because the error margins of both are wide, and the two are not measuring the same aspect of the deformity. The Quantec system is useful in patient monitoring as an alternative to radiography, without diminishing the standard of care.

Surface topography, Cobb angles and cosmetic change in scoliosis

Background
Medicine is a scientific art: once science is not clear, choices are made according to individual and collective beliefs that should be better understood. This is particularly true in a field like adolescent idiopathic scoliosis, where currently does not exist definitive scientific evidence on the efficacy either of conservative or of surgical treatments.

https://link.springer.com/content/pdf/10.1186%2F1748-7161-1-4.pdf

Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper

The aim of this work was to develop a low-cost automated system to measure the three-dimensional shape of the back in patients with scoliosis. The resulting system uses structured light to illuminate a patient’s back from an angle while a digital photograph is taken. The height of the surface is calculated using Fourier transform profilometry with an accuracy of ±1 mm. The surface is related to body axes using bony landmarks on the back that have been palpated and marked with small coloured stickers prior to photographing. Clinical parameters are calculated automatically and presented to the user on a monitor and as a printed report. All data are stored in a database. The database can be interrogated and successive measurements plotted for monitoring the deformity changes. The system developed uses inexpensive hardware and open source software. Accurate surface topography can help the clinician to measure spinal deformity at baseline and monitor changes over time. It can help the patients and their families to assess deformity. Above all it reduces the dependence on serial radiography and reduces radiation exposure when monitoring spinal deformity.

A new system for measuring three-dimensional back shape in scoliosis

Objectives This study evaluates the Walter Reed Visual Assessment Scale (WRVAS) compared with clinical parameters and written descriptions of the deformity from idiopathic scoliosis patients and their parents. Summary of background data The WRVAS demonstrates seven visible aspects of spinal deformity in an analogue scale. Higher scores reflect worsening deformity. Materials and methods The WRVAS was administered to 182 idiopathic scoliosis patients at four centers in conjunction with open-ended questions about patients' and their parents' perceptions of their spinal deformity. The open-ended responses were categorized as either "deformity noted" or "no deformity noted." Results WRVAS scores strongly correlate with curve magnitude (P = 0.01) and clearly differentiates curves of 30 degrees or more from lesser curves. Among treatment groups, patients with surgery recommended had significantly higher scores than that of other patients. The instrument differentiated those noting no deformity from those noting a deformity. The correlation between patients' and parents' scores was high (Spearman's rho = 0.8). When a deformity was noted, parents gave higher scores than did their children for rib prominence, shoulder level, scapular rotation, and the total score, but not for the other dimensions. Conclusions Increasing scores of the WRVAS are strongly correlated with curve magnitude lending construct validity to this type of assessment tool. Patients with "surgery recommended" report more visible deformity on the scale than observed, braced, and postoperative patients, supporting the hypothesis that surgery improves the perceived appearance. Parents perceive more deformity of the ribs and shoulders more than did the patients, but other aspects of the deformity are identified equally. WRVAS scores correlate significantly with curve magnitude and treatment. Parents and patients have similar scores, but with parents perceiving more deformity of the ribs and shoulders than patients.

Analysis of patient and parent assessment of deformity in idiopathic scoliosis using the Walter Reed Visual Assessment Scale.

Cosmesis is important in the treatment of adolescent idiopathic scoliosis patients. The aim of this study was to quantify the cosmetic defect using parameters of the ISIS (Oxford Metrics Ltd., Oxford, England) scan. Ten nonmedical judges scored photographs of 100 adolescent idiopathic scoliosis patients based on cosmetic criteria. This Cosmetic Spinal Score proved to be a reliable figure. The Cosmetic Spinal Score was then compared with ISIS parameters and the Cobb angle. An equation based on ISIS parameters was developed, which could predict Cosmetic Spinal Score with sufficient reproducibility to have a useful clinical application. Bracing reduced the rib hump but not enough to improve the cosmetic appearance. Spinal fusion and Harrington instrumentation improved all measured parameters influencing physical appearance.

A. H. R. W. Simpson

Papers

Quantifying the cosmetic defect of adolescent idiopathic scoliosis