Showing papers on "Cobb angle published in 1993"
TL;DR: The authors studied 200 patients older than ago 50 years with back pain and recent onset of secolicsis and found that a Cobb angle of 30 or more, lateral vertebral translation of 6 mmor more, and the prominence of L5 in relation to the intercrest line were important factors in predicting curve progression.
Abstract: Scoliosis with progressive deformity can develop late in life. The authors studied 200 patients older than age 50 years with back pain and recent onset of scoliosis. Seventy-one percent of patients were women, and no patient had undergone spinal surgery. The curves involved the area from T12 to L5 with the apex at L2 or L3 and did not exceed 60 degrees. Degenerative facet joint and disc disease always were present, and the curves were associated with a loss of lumbar lordosis. Forty-five patients with severe pain and neurologic deficits were studied using myelography. Indention of the column of contrast medium was seen at several levels but was most severe at the apex of the curve. It was least severe at the lumbosacral joint. The curves progressed an average of 3 degrees per year over a 5-year period in 73% of patients. Grade 3 apical rotation, a Cobb angle of 30 or more, lateral vertebral translation of 6 mm or more, and the prominence of L5 in relation to the intercrest line were important factors in predicting curve progression.
223 citations
TL;DR: An equation based on ISIS parameters was developed, which could predict Cosmetic Spinal Score with sufficient reproducibility to have a useful clinical application and proved to be a reliable figure.
Abstract: 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.
112 citations
TL;DR: Investigation of the natural course of the spinal deformity in Duchenne muscular dystrophy and its clinical relevance found that operation may be necessary in patients in whom Cobb angle will progress unremittently in type 1, and spinal surgery justifiable in type 2.
Abstract: To investigate the natural course of the spinal deformity in Duchenne muscular dystrophy (DMD) and its clinical relevance, longitudinal series of spinal radiographs and medical records of 46 patients with DMD were reviewed. The natural course of the deformity was classified into three types; type 1 (n=21), unremittent progression of scoliosis with kyphosis; type 2 (n=18), transition from kyphosis to lordosis before age 15 years; and type 3 (n=7), less deformity without prominent longitudinal changes. Age at loss of ambulatory ability was not a predictor of type. Neither was the age at which the Cobb angle was 30 o correlated with the rate of subsequent progression
85 citations
TL;DR: It was concluded that there is a statistically and clinically significant dally increase of curve severity in moderate to severe idiopathic scoliosis.
Abstract: To investigate the possible influence of gravity on daily variations of curve magnitude in adolescent idiopathic scoliosis, standardized anteroposterior standing radiographs of the spine were taken at 8:00 AM and repeated in the same conditions at 8:00 PM on the same day, 19 girls with idiopathic scoliosis, aged 10-16 years were included. The Cobb angle of the primary thoracic curve was measured blindly by four skilled orthopaedic surgeons. The mean interobserver variation in measuring Cobb angles on the 38 radiographs was 1.6 degrees. The average Cobb angle on morning radiographs was 60 degrees (range, 42-91 degrees) as compared to 65 degrees (range, 47-89 degrees) in the afternoon, a significant (P < 0.001) difference using a paired two-sided Student t test. It was concluded that there is a statistically and clinically significant daily increase of curve severity in moderate to severe idiopathic scoliosis.
81 citations
TL;DR: The forward bending test is preferable to moiré topography in screening for scoliosis, and a hump size of 6 mm at an average age of 10.8 years is the nearest to optimal as a screening threshold.
Abstract: A cohort of children was followed-up annually from an average age of 10.8-13.8 years to assess various measures of trunk asymmetry for their predictive value in the screening of scoliosis. Of 1060 children, 855 (80.7%) participated in the final examination. Trunk asymmetry was measured by the forward bending test and moire topography. A posteroanterior standing radiograph of the spine was taken of those 250 (29.2%) children who had a trunk hump > or = 8 mm. Only 8.3% of the children were found to be symmetric (hump 0-2 mm) in the forward bending test: 65.5% had a hump of 3-7 mm and 26.2% had a hump > or = 8 mm at 13.8 years. Also, moire fringe asymmetry proved to be common (prevalence of asymmetry > 1 fringe 47.3%), but its correlations with rib hump (r = 0.16) and Cobb angle (r = 0.12) were low. At the final examination, the prevalence of scoliosis (Cobb angle > or = 10 degrees) was 9.2%. Two girls (0.2%) needed brace treatment. The forward bending test is preferable to moire topography in screening for scoliosis, and a hump size of 6 mm at an average age of 10.8 years is the nearest to optimal as a screening threshold.
74 citations
TL;DR: A number of characteristics related to trunk asymmetry, posture and growth, independently of one another predict the development of manifest scoliosis in prepubertal children.
Abstract: Several anthropometric measurements were studied for their prediction of scoliosis in 896 children (430 girls and 466 boys) who were free from scoliosis at entry. The children were examined annually from the average age of 10.8 to 13.8 years to follow up their trunk asymmetry, posture, and growth. Scoliosis developed in 24 boys and 41 girls (Cobb angle > or = 10 degrees in a posteroanterior standing radiograph) during the 3 years. In both girls and boys, trunk asymmetry measured by the forward bending test was found to be the most powerful determinant of the incidence of scoliosis. In the whole cohort the adjusted odds ratio was 1.61 and its 95% confidence interval was 1.42-1.82 per one millimeter increase in trunk hump. Using spinal pantography the degree of thoracic kyphosis in girls (odds ratio = 1.05, 95% confidence interval = 1.01-1.09, per one degree) and the degree of lumbar lordosis in boys (odds ratio = 1.07, 95% confidence interval = 1.01-1.13, per one degree) were significant predictors of future scoliosis. In the children both sexes who eventually had scoliosis, body height, sitting height, and growth of sitting height were greater than in other children, but these factors carried no statistical significance in the logistic analyses. There were differences between the prescoliotic girls and other girls in both mean age (11.8 vs 12.1 years, P = 0.02) and value (5.5 cm vs 6.1 cm/yr, P = 0.08) of peak sitting height velocity.(ABSTRACT TRUNCATED AT 250 WORDS)
71 citations
TL;DR: It is demonstrated that the Boston brace does not improve, but prevents progression of vertebral rotation, translation, rib hump, and Cobb angle in idiopathic scoliosis and the sagittal diameter of the thoracic cage was significantly decreased.
Abstract: The long-term effect of Boston brace treatment was investigated by computed tomography measurements before treatment, after bracing, and at mean follow-up at 8.5 years in 25 patients with idiopathic scoliosis. At follow-up, the pretreatment Cobb angle, the vertebral rotation, the rib hump, and the translation of the apical vertebra were not significantly changed. The sagittal diameter of the thoracic cage was significantly decreased at follow-up. The current study demonstrates that the Boston brace does not improve, but prevents progression of vertebral rotation, translation, rib hump, and Cobb angle in idiopathic scoliosis. The reduced sagittal diameter is noteworthy and may be of importance for cosmesis and pulmonary function.
71 citations
TL;DR: The optoelectronic device's angle, a measure of centroid curvature, correlated highly with the Cobb angle for primary spinal curves, and the highest correlation was observed in thoracolumbar curves.
Abstract: In this study, truncal deformity in patients with scoliosis was evaluated by circumferential scanning using an optoelectronic device (Optronic Torsograph, Anima Corp., Tokyo, Japan). This device generates cross-sectional skin surface topography at 10 axial levels to provide a three-dimensional representation of truncal shape. Ninety-three patients with suspected idiopathic scoliosis were evaluated with conventional Cobb measurements, and their parameters were computed using the device's measurements. The geometric cross-sectional indexes correlated poorly with the Cobb angle and were highly variable during repeated measurements. The optoelectronic device's angle, a measure of centroid curvature, correlated highly with the Cobb angle for primary spinal curves. The highest correlation was observed in thoracolumbar curves. This optoelectronic device has clinical relevance as a method for further scoliosis screening and monitoring the progression of spinal curvature in a patient.
42 citations
Journal Article•
TL;DR: Radiographic outcome and complications of Harrington-DTT (H) and Cotrel-Dubousset (CD) instrumentation of idiopathic adolescent thoracic scoliosis were compared retrospectively and there were no neurologic complications in either of the groups.
Abstract: Radiographic outcome and complications of Harrington-DTT (H) and Cotrel-Dubousset (CD) instrumentation of idiopathic adolescent thoracic scoliosis were compared retrospectively. The patient material consists of 55 consecutive patients in the H group and 52 consecutive patients in the CD group. The mean age at operation was 15±2 years (range, 11-19 years) in both groups. The follow-up interval was 43±18 months (range, 17-91 months) in the H group and 28±11 months (range, ten to 53 months) in the CD group (p=0.0001). The preoperative radiographic measurements (Cobb angle of primary and secondary-curve, apical rotation, thoracic kyphosis, lumbar lordosis) were fully comparable in both groups
41 citations
TL;DR: Comparisons between the Cobb and Ferguson measures in radiographs of patients with idiopathic scoliosis to test whether the methods were really different, and to compare their precision, concluded that both methods can be useful for measuring curve magnitude.
Abstract: In scoliosis, the Cobb measure of curve severity has been recommended over the Ferguson method because it had greater magnitude and appeared more sensitive to changes during progression and after treatment. This study made comparisons between the Cobb and Ferguson measures in radiographs of patients with idiopathic scoliosis to test whether the methods were really different, and to compare their precision. In 138 observations of 77 untreated patients there was a very high correlation (R2 = 0.98) between Cobb and Ferguson angle, with Cobb angle averaging 1.35 times greater. For sequential measures (mean interval 10 months), the percent changes agreed closely (R2 = 0.5). The relationship between Cobb and Ferguson angles remained the same in measurements of 24 patients wearing a brace compared with the unbraced condition and in 18 patients measured before and after Harrington rod surgery. Repeated measurements were made by three observers with the apex and end vertebrae pre-marked and held constant. For Cobb angle, the greatest range of measurements on any film was 8 degrees (pooled SD = 1.3 degrees). For Ferguson angle the greatest range was also 8 degrees (pooled SD = 1.8 degrees). Ferguson angle was slightly more sensitive to incorrect selection of end vertebrae. It was concluded that both methods can be useful for measuring curve magnitude. Ferguson angle should be measured and then adjusted by multiplying it by 1.35 in situations where Cobb angle measurement is technically difficult or invalid. Ferguson angle is better suited to automated measurement.
35 citations
TL;DR: Both measured and simulated changes in vertebral transverse plane rotations and in rib angulations were small and the greatest source of errors appeared to be inadequate representation of in vivo motion segment behavior by in vitro measured stiffness properties.
Abstract: Harrington distraction rod surgery on six female patients with idiopathic scoliosis was simulated in three-dimensional osseoligamentous finite element models with individual geometry taken from preoperative stereo roentgenographic reconstructions of the spine and ribcage and compared with the measured outcome. Boundary conditions at the ends of the spine were used to maintain pelvis and head alignment. Published material and flexibility properties were used. The amount of hook distraction was calculated from measured changes in the distance between the hook sites (range, 13-27 mm). Initial simulations underestimated the Cobb angle correction by an average 6%. They underestimated the spinal elongation by 36% and predicted an average 12 degrees increase in kyphosis angle compared with an actual 10 degrees average decrease. Agreement for sagittal plane changes improved in five cases when the beams representing the motion segments were displaced posteriorly. In the sixth case (with the rod applied over a lordotic spinal region), agreement was improved with the motion segment beams displaced anteriorly. The amount of the beam displacement that gave the best agreement was variable, and we were not able to predict it for each individual. Both measured and simulated changes in vertebral transverse plane rotations and in rib angulations were small. The greatest source of errors in these simulations appeared to be inadequate representation of in vivo motion segment behavior by in vitro measured stiffness properties.
TL;DR: It is demonstrated that the long-term effect of Harrington instrumentation was limited to an improved Cobb angle; no correction of the rotational or sagittal deformities were achieved.
Abstract: The long-term effect of Harrington instrumentation was investigated using posteroanterior radiographs and computed tomographic measurements preoperatively, postoperatively, and at a mean follow-up at 10.8 years in 33 patients with idiopathic scoliosis. No patient was lost from long-term follow-up. At follow-up, the mean Cobb angle was improved by 23.7 (40%) compared with the preoperative findings. The rotation of the apical vertebra was increased significantly. The rib hump, the translation of the apical vertebra, and the sagittal diameter of the thoracic cage were unchanged. At follow-up, the mean thoracic kyphosis was 17.3, and lumbar lordosis was 22.0. This study demonstrated that the long-term effect of Harrington instrumentation was limited to an improved Cobb angle; no correction of the rotational or sagittal deformities were achieved.
TL;DR: Electromyographic investigations in 316 patients with a mean age of 20 years and a mean Cobb curvature angle confirmed improvement of postural performance capacity in patients with idiopathic scoliosis after an intensive in-patient Schroth rehabilitation programme.
Abstract: In order to monitor changes in postural performance capacity in patients with idiopathic scoliosis after an intensive in-patient Schroth rehabilitation programme lasting several weeks, we undertook electromyographic investigations in 316 patients with a mean age of 20 years (range 8-76 years) and a mean Cobb curvature angle of 38.2 degrees (range 10 degrees-147 degrees). Electromyographic activity was recorded by means of surface electrodes in the thoracic and lumbar region at the level of the apical vertebra, paravertebrally on both sides of the erector spinae muscle during trunk lifting from the prone position. Two hundred and fifty-nine recordings without artefacts were evaluated. Significant reductions in muscle activity of 6.85% in the thoracic convex region (P < 0.05) and of 14.2% (P < 0.001) on the lumbar convex side were found. The activity quotient (convesx/concave) was reduced by 11.99% (P<0.001) in the thoracic region and by 7.91% (P<0.01) in the lumbar region. These findings confirm the improvement of postural performance capacity after an intensive in-patient Schroth rehabilitation programme. As the imbalance of electromyographic activity may be influenced by scoliosis-specific exercises leading to a highly significant reduction of the Cobb angle, it is assumed to be secondary to the development of the scoliotic curve and may not be a primary factor in the aetiology of idiopathic scoliosis.
TL;DR: A computer‐implemented biomechanical model of a thoracolumbar spine and deformable rib cage was used to investigate the influence of spine morphology and rib cage stiffness properties on the rib cage deformities that arise from scoliosis and to study the relationship of actual rib distortions with those seen on computed tomography (CT) scans.
TL;DR: This is a report of a 6-year-old boy who was operated upon twice for congenital esophageal atresia immediately after birth, and at the age of 5 years developed a high left-convex thoracic scoliosis with Cobb angle of 15° due to an unilateral acquired fusion between the dorsal ends of the fourth, fifth, and sixth ribs.
Abstract: This is a report of a 6-year-old boy who was operated upon twice for congenital esophageal atresia immediately after birth, via a right posteriolateral thoracotomy without rib excision, and at the age of 5 years developed a high left-convex thoracic scoliosis with Cobb angle of 15° due to an unilateral acquired fusion between the dorsal ends of the fourth, fifth, and sixth ribs. The scoliosis had progressed by 5° 1 year later. Although congenital scoliosis associated with rib fusion is a well known entity, to the authors' knowledge this is the first report of an acquired rib fusion producing progressive scoliosis.
TL;DR: These results show that a slight VRA to the right is a common feature in the normal spine, and that the VRA increases with progressive lateral deviation of the spine.
Abstract: In order to investigate the development of the vertebral axial rotation in patients with early scoliosis, the vertebral rotation angle (VRA) was quantified on the basis of 132 anteroposterior radiographs obtained from patients with diagnosed or suspected scoliosis. The rotation was measured in the apical vertebra and in the two suprajacent and two subjacent vertebrae. The radiographic material was divided into a control reference group and three scoliotic groups with varying Cobb angle from 4° up to 30°. In the reference group a slight vertebral rotation was significantly more often seen to the right. In the scoliotic groups, the rotation was most pronounced in the apical segments. The mean VRA toward the convex side was significantly increased in the vertebrae just suprajacent to the apex in curves with a Cobb angle of 8°–15° and in the cranial four vetebrae in curves with a Cobb angle of 16°–30°. Atypical vertebral rotation to the opposite side of the major curve was observed in 12.8% of the cases. There was a significant positive correlation between the VRA and the Cobb angle. These results show that a slight VRA to the right is a common feature in the normal spine, and that the VRA increases with progressive lateral deviation of the spine. It is concluded that the coronal plane deformity in early idiopathic scoliosis is accompanied and probably coupled to vertebral rotation in the horizontal plane.
TL;DR: There was a correlation between the magnitude of Cobb angle and that of the vertebral rotation in scoliosis associated with both CP and PMD, but the ratio of spinal rotation to Cobb angle in the former was lower than that in the latter.
Abstract: The authors analyzed lateral deviation, anteroposterior deformity, and rotation of the spinal column of 11 patients with scoliosis associated with cerebral palsy (CP) and 11 patients with progressive muscular dystrophy (PMD). There was a correlation between the magnitude of Cobb angle and that of the vertebral rotation in scoliosis associated with both CP and PMD, but the ratio of spinal rotation to Cobb angle in the former was lower than that in the latter, The magnitudes of thoracic kyphosis and of lumbar lordosis were not correlated with Cobb angle in either group, but the sagittal plane deformity in the CP patients was less severe than that in the PMD patients, and the latter demonstrated kyphosis of the lumbar spine and lordosis of the thoracic spine.
TL;DR: While CDI improves the coronal and sagittal plane deformity permanently, the effect on vertetebral rotation and the rib hump deteriorates with time, and this was followed by significant loss of correction, and at follow-up the vertebral rotation andThe size of rib hump were not significantly better than preoperatively.
Abstract: The effect of Cotrel-Dubousset instrumentation (CDI) on the three-dimensional spinal deformity in 24 consecutive patients with idiopathic scoliosis was investigated by posteroanterior and lateral radiographs and by computed tomography preoperatively, postoperatively, and at a mean follow-up of 3.2 years (range 2.0–5.3 years). At follow-up the mean Cobb angle was decreased by 73%, and the translation of the apical vertebra was significantly decreased by 33%. The sagittal contour was significantly improved with thoracic kyphosis T5–12 increased by 46% (6.9°) and lumbar lordosis L1–5 increased by 28% (10.3°) at follow-up. The sagittal diameter was significantly improved by 5 mm at follow-up. Although the vertebral rotation and the size of rib hump was improved postoperatively, this was followed by significant loss of correction, and at follow-up the vertebral rotation and the size of rib hump were not significantly better than preoperatively. The study indicates that while CDI improves the coronal and sagittal plane deformity permanently, the effect on vertetebral rotation and the rib hump deteriorates with time.
TL;DR: Le volume résiduel représentait 48% de the capacité vitale préopératoire, alors qu'il était de 35% chez les témoins normaux, while the patients présentant des anomalies thoraciques multiples, qui n'ont pas nécessité de chirurgie, n' ont pas présentsé une telle réduction de la capacite vitale.
Abstract: This paper presents the results of pulmonary function analysis in 141 subjects. Thirty-five of these were patients with adolescent idiopathic scoliosis, 36 had congenital scoliosis, and the remaining 70 were age-, sex-, height-, weight- and arm-span-matched normal subjects used as controls for adolescent idiopathic scoliosis. The patients with adolescent idiopathic scoliosis had their pulmonary function evaluated pre- and post-operatively. At pre-operative evaluation the mean age was 13.7 years and the mean cobb angle 48°; at post-operative evaluation the figures were 17.1 years and 36° respectively. In the congenital scoliosis group the mean age was 14.5 years and the mean Cobb angle 42°, and pulmonary functions were evaluated at a minimum of 3 years after surgery. The results are as follows: Adolescent idiopathic scoliosis: (i) Marked disproportion was found in the pulmonary volumes following spinal surgery. After taking growth of the thoracic cage into account, the total lung capacity remained unchanged whilst the vital capacity was significantly reduced and there was a significant increase in residual volume. (ii) This disproportionate increase in residual volume was further confirmed by very highly significantly increased residual volume/vital capacity and residual volume/total lung capacity ratios at post-operative evaluation compared to pre-operative ratios (Mann-Whitney test, P=0.001). (iii) The residual volume was 48% of vital capacity pre-operatively compared to 35% in normal controls. The percentages increased to 70% post-operatively, whilst it was unchanged in the matched controls. Congenital scoliosis: (i) The mean residual volume was markedly increased (154% of predicted value). (ii) Vital capacity was significantly reduced in surgically treated patients (68% of predicted values). (iii) This pattern of reduced vital capacity was more marked in those patients who had multiple thoracic anomalies and were treated surgically (46% of predicted value). However, those patients with multiple thoracic anomalies who did not require surgery did not show such reduction of vital capacity. Comparison between idiopathic and congenital scoliosis: (i) In unoperated patients, the percentages of predicted values of total lung capacity, vital capacity and residual volume were significantly greater in congenital scoliosis than in adolescent idiopathic scoliosis. (ii) Post-operatively there was no significant difference in the percentages of predicted values of total lung capacity, vital capacity and residual volume between patients with congenital scoliosis and those with adolescent idiopathic scoliosis, despite the difference in pathogenesis. These findings have relevance to scoliotic patients treated with spinal fusion with regard to their capability to perform strenuous physical activities.
Journal Article•
TL;DR: In two different residential areas in Baghdad, 4295 schoolchildren aged 8-13 years from two different socioeconomic groups were screened for scoliosis by using the forward bending test and a scoliometer to measure the angle of trunk rotation.
Abstract: In two different residential areas in Baghdad, 4295 schoolchildren aged 8-13 years from two different socioeconomic groups were screened for scoliosis by using the forward bending test and a scoliometer to measure the angle of trunk rotation. A total of 188 children were referred to hospital, but the actual number seen was 140. A standing anteroposterior X-ray was taken of those with abnormal clinical findings and 101 children were considered to suffer from scoliosis (with a Cobb angle of 5° or more). The predictive value of a positive test was 72.14%. The overall prevalence of scoliosis was 2.4%; 86.14% of the curves were idiopathic. Idiopathic scoliosis was more prevalent in the adolescent (3.4%) than in the preadolescent period (1.8%)
Journal Article•
TL;DR: In this article, the results of the tests have demonstrated that correction of the scoliotic curve improves pulmonary function: however, the improvement does not match the degree of achieved scoliosis curve correction.
Abstract: The purpose of this study has been to establish pulmonary function improvement achievable by surgical correction of the scoliotic curve as compared with the achieved curve correction. The study comprised two distinct groups of patients with an average age of 15 years with idiopathic thoracic scoliosis. The first group of 33 patients were treated surgically: an average Cobb angle of 72 degrees was postoperatively reduced to 32.6 degrees. The second group of 30 patients of the same age with an average Cobb angle of 33 degrees who were not treated surgically. Cardiorespiratory function parameters were tested--preoperatively and 24 months after surgery--by spirometry and plethysmography, arterial blood gas analysis, and the exercise tolerance test. The results of the tests have demonstrated that correction of the scoliotic curve improves pulmonary function: however, the improvement does not match the degree of achieved scoliotic curve correction. Statistical analysis surgically and nonsurgically treated patients with the same degree of spinal curvature disclosed a difference in cardiopulmonary function--specifically, ther VC and PaO2 variables--to the advantage of nonsurgically treated patients. This observation suggests partial irreversibility of ventilation and perfusion in surgically treated patients.