Measurement of scoliosis cobb angle by end vertebra tilt angle method jing wang1, jin zhang1, rui xu2, tie ge chen1, kai sheng zhou1 and hai hong zhang1 abstract background. I am wondering if anyone has had any problem finding out the actual cobb angle of their curves. Cobb angle measurement of scoliosis using computer measurement of digitally acquired. There was no variation in the choice of the end vertebrae of the main curve. Fixed effect model analysis demonstrated that, although a statistically significant difference existed between the 3 methods of measuring the cobb angle p scoliosis when the spine has a sideways curvature of at least 10 degrees, which is measured by the cobb angle. To compare the measurement of the cobb angle on printed radiographs and on scanned radiographs viewed through the software pixviewer. Curves that are less than 10 degrees are not considered to represent scoliosis, but rather a minor spinal asymmetry.
Idiopathic scoliosis treatment depends on the accurate assessment of the cobb angle, which is usually performed manually. The most common quantification of scoliosis is the cobb angle 4. In 1948 he outlined how to measure the angle of the spinal curve, a method used worldwide to quantify spinal deformities. Demonstration of 2020 imagings opalrad chiropractic digital xray software tool cobb angle see all the opalrad chiro videos. A cobb angle describes the maximum distance from straight a scoliotic curve may be. While the cobb angle is the current standard for scoliosis measurement, its important to recognize three significant points. The cobb angle measurement is the gold standard of scoliosis evaluation endorsed by scoliosis research society. The severity definition for scoliosis is determined using the cobb angle as shown in table 1. Cobb angle measurement of kyphosis and scoliosis full. The traditional uniplanar t1s1 measurement method is not reflecting the actual three dimensional curvature of a scoliotic spine and is therefore not accurate. A cobb angle greater than 40 degrees denotes severe scoliosis. In our study, we evaluated the radiographs of 23 patients, measuring the cobb angle in printed film and in digitalized form using pixviewer software. The cobb angle is best understood within the context of the individual patient.
To automatically measure the cobb angle and diagnose scoliosis on chest xrays, a computeraided method was proposed and the reliability and accuracy were evaluated. Cobb suggested that the angle of curvature be measured by drawing lines parallel to the upper border of the upper vertebral body and the lower border of the lowest vertebra of the structural curve, then erecting perpendiculars from these lines to cross each other, the angle between these perpendiculars being the angle of curvature. Therefore, cobb angle measurement by surgimapspine software both in coronal and sagittal alignment may be more accurate when compared with those measured with the manual method. Aldt does not show the severity of the cobb angle, however it is an easy way to gain another dimension which is useful. A software program to measure the threedimensional length. Increased adoption of picture archiving and communication pacs systems within hospitals has reduced the need for manual measurement of scoliosis cobb angles in some cases, as spinal curves can be measured directly on digital radiographs using software tools built into the imaging viewing software. Cobb angle is used worldwide to measure and quantify the magnitude of spinal deformities, especially in the case of scoliosis.
Measurement of scoliosis cobb angle by end vertebra tilt. Measurement under a few degrees is and will continue to be difficult unless there can be a physical method of measurement thats accurate and then averaging over a period of time to account for daily movement. To measure and calculate the scoliosis cobb angle by end vertebra tilt angle method tilt angle method and assess its accuracy and usability. Use of the iphone for cobb angle measurement in scoliosis ncbi. John r cobb, an american orthopedic surgeon, to measure the angle of spinal curves.
In other words, a 40 degree cobb angle is more than twice as severe as a 20 degree cobb angle. Scoliosis severity is moderate when the cobb angle ranges from 20 to 40 degrees. Pdf use of the iphone for cobb angle measurement in scoliosis. Cobb angle used to measure scoliosis curves spinehealth. Reducing a 60 degree scoliosis by 10 degrees represents a far greater accomplishment than reducing a 20 degree scoliosis down to 10 degrees. Two mask rcnn models as the core of a computeraided method were used to separately detect and segment the spine and all vertebral bodies on chest xrays, and the cobb angle of the spinal curve was measured from. Therefore the examiner performing the radiationfree measurement of the scoliotic cobb angle does not affect the system results 10.
The cobbmeter is another alternative for measuring cobb angle in scoliosis. The scoliosis cobb angle can be measured accurately and rapidly using the principle of the cobb angle being equal to the sum of tilt angles of the upper and lower end vertebra, where in. Cobb angles were then measured on the digital images using standard measurement software. It is used as the standard measurement to quantify and track the progression of scoliosis. The cobb angle is also the preferred method of measuring posttraumatic kyphosis in a recent metaanalysis of traumatic spine fracture classifications. The cobb angle of a scoliotic curve is the angle formed by the intersection of two lines, one parallel to. Most scoliosis curves are between 10 to 40 degrees in magnitude. In order to quantify and track the progression of scoliosis a standard measurement known as the cobb angle named after dr. Measurement of scoliosis cobb angle by end vertebra tilt angle. Manual measurements, however, can lead to observer variations, which depend on the correct selection of the curvature superior and inferior vertebrae in order to draw the needed lines for cobb angle measurements. To determine if bone density scanning dexa and the use of a computer software program can make accurate measurements of the curvatures of the spine cobb anglein patients with kyphosis and scoliosis compared to xrays of the spine. A deep neural network dnn was trained with vertebral patches extracted from spinal model radiographs. The cobb angle has proven itself to be a great diagnostic tool for patients with abnormal scoliosis, kyphosis and lordosis curvatures.
The cobb angle is used on xray to measure the angle between the most angulated vertebras that make up the curvature. In addition, comparing the patients cobb angle to past exams can help determine whether or not the curve is getting progressively worse, as well as whether treatment is working or even needed. The measurement of the cobb angle is an important basis for selecting therapeutic methods and evaluating therapeutic effects. Pdf measurement of scoliosis cobb angle by end vertebra. Evaluation of a computeraided method for measuring the. Scoliosis cobb angle scoliosis scoliosis scoliosis. Scoliosis cobb angle is a diagnostic tool that is utilized to measure the exact degree of side to side spinal curvature using an xray film. Scoliosis involves all three dimensions of the spine. Objective the aim of the study was to verify the method of ca measurements on digital radiographs using bunnell. Scoliosis is an abnormal sideways curvature of the spine with at least a 10 degree cobb angle. To develop a computeraided method that reduces the variability of cobb angle measurement for scoliosis assessment.
The cobb angle drives clinical decision making and is the primary measurement by which all natural history studies have been conducted. The doctor told us, at an appointment, that my daughters angles were t56 and l50. Scoliosis cobb angle scoliosis cobb angle is a diagnostic tool that is utilized to determine and measure the exact degree of sidetoside spinal curvature using an xray film. John r cobb where he outlined how to measure the angle of the spinal curve. Cobb angle is a measurement of the degree of sidetoside spinal curvature, which is a deformity you may know as scoliosis. One week later he changed his reading to t52 and l49. Cobb angle measurements on digital radiographs using. To measure the cobb angle, one must first decide which vertebrae are the endvertebrae of the curve deformity the vertebra whose endplates are most tilted towards each other lines are then drawn along the endplates, and the angle between the two lines, where they intersect, measured. Cobb angle measurement of spine from xray images using. The variety of software used to assess radiographs might make the ca measurements cumbersome in everyday clinical practice.
The cobb angle is used to measure the curvature of the spine. With this measurement, doctors are able to judge the severity of the scoliosis, assess the curve and recommend treatment options. The condition of a spine is associated with the spinal curve. The interference of line marking in imaging data pixel in the two groups was compared using beyond compare software. As the cobb angle increases, the actual curvature of the spine becomes exponentially more severe. For instance, if a 30degree cobb angle is found in a 10yearold girl who has a lot of skeletal growth left, a brace is likely to be recommended. As such, it can be used to reduce costs for school screening programs. Lines are drawn on the xray or a computer program assists to calculate the angle. Here is a general outline of cobb angle ranges and what they could indicate in idiopathic scoliosis found in children and adolescents. Conclusion the computeraided method has potential for automatic cobb angle measurement and scoliosis diagnosis on chest xrays. The cobb angle of the spinal curve was calculated automatically from the vertebral slopes predicted by the dnn. Iphone app use to cobb angle in adolescent idiopathic scoliosis.
Easyangle can measure the cobb angle on scoliosis in just two clicks. Understanding cobb angles and what it means for scoliosis. A cobb angle in the range of 10 to 20 degrees is considered as mild scoliosis. Validity of cobb angle measurements using digitally. However, it is still the main standard for diagnosis, monitoring, therapeutic planning, and epidemiologic analysis of scoliosis. It is a twodimensional measurement of a threedimensional condition. Cobb angle measurements on digital radiographs using bunnell scoliometer. The coronal cobb angle is usually used for the assessment and treatment of scoliosis. This is a transparent online protractor, also helps you measure angles in a picture, you can easily measure the angle of any object around you, taking a picture and uploading it, then dragging the midpoint of the protractor to the vertex of the angle. Traditionally, cobb angles have been measured using protractor and. Measure cobb angle on scoliosis easyangle digital goniometer.
Scoliosis is a common deformity, and its severity is usually assessed by measuring the cobb angle on the spinal xray film. The measurement of cobb angle involves estimating the angle between the two tangents of the upper and lower endplates of the upper and lower end vertebra, respectively, as shown in figure 3. Measurement of cobbs angle by software anglespine pavel cerny. Measuring the cobb angle using an iphone measure app. Background electronic rulers on computer screen are used to measure the cobb angle ca instead of traditional methods with rulers, protractors and pens. Reliability and reproducibility analysis of the cobb angle. Typically, curves under 20 degrees in adults are not worrisome. Computerbased cobb angle measurement using deflection. Katz participated in a panel discussion titled trends in adolescent idiopathic scoliosis concerning cobb angle vs. The spinal measurement software sms is an alternative to conveniently measure the true spines length. A scoliosis is defined as a lateral spinal curvature with a cobb angle of 10 or more 4.
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