European Spine Journal

, Volume 15, Issue 7, pp 1144–1149

Rasterstereographic analysis of axial back surface rotation in standing versus forward bending posture in idiopathic scoliosis

  • Lars Hackenberg
  • Eberhard Hierholzer
  • Viola Bullmann
  • Ulf Liljenqvist
  • Christian Götze
Original Article


The forward bending test according to Adams and rib hump quantification by scoliometer are common clinical examination techniques in idiopathic scoliosis, although precise data about the change of axial surface rotation in forward bending posture are not available. In a pilot study the influence of leg length inequalities on the back shape of five normal subjects was clarified. Then 91 patients with idiopathic scoliosis with Cobb-angles between 20° and 82° were examined by rasterstereography, a 3D back surface analysis system. The axial back surface rotation in standing posture was compared with that in forward bending posture and additionally with a scoliometer measurement in forward bending posture. The changes of back shape in forward bending posture were correlated with the Cobb-angle, the level of the apex of the scoliotic primary curve and the age of the patient. Averaged over all patients, the back surface rotation amplitude increased from 23.1° in standing to 26.3° in forward bending posture. The standard deviation of this difference was high (6.1°). The correlation of back surface rotation amplitude in standing with that in forward bending posture was poor (R2=0.41) as was the correlation of back surface rotation in standing posture with the scoliometer in forward bending posture measured rotation (R2=0.35). No significant correlation could be found between the change of back shape in forward bending and the degree of deformity (R2=0.07), likewise no correlation with the height of the apex of the scoliosis (R2=0.005) and the age of the patient (R2=0.001). Before forward bending test leg length inequalities have to be compensated accurately. Compared to the standing posture, forward bending changes back surface rotation. However, this change varies greatly between patients, and is independent of the type and degree of scoliosis. Furthermore remarkable differences were found between scoliometer measurement of the rib hump and rasterstereographic measurement of the vertebral rotation. Therefore the forward bending test and the identification of idiopathic scoliosis rotation by scoliometer can be markedly different compared to rasterstereographic surface measurement in the standing posture.


Rasterstereography Adams test Scoliometer Forward bending test Idiopathic scoliosis 


  1. 1.
    Adams W (1865) Lectures on the pathology and treatment of lateral and other forms of curvature of the spine. Churchill, LondonGoogle Scholar
  2. 2.
    Amendt LE, Ause-Ellias KL, Eybers JL, Wadsforth CT, Nielsen DH, Weinstein SL (1990) Validity and reliability testing of the Scoliometer. Phys Ther 70:108–116PubMedGoogle Scholar
  3. 3.
    Bunnel WP (1984) An objective criterion for scoliosis screening. J Bone Joint Surg 66:1381–1387Google Scholar
  4. 4.
    Burwell RG, Webb JK, More EJ (1981) School screening for scoliosis [letter]. Lancet 2:863PubMedCrossRefGoogle Scholar
  5. 5.
    Burwell RG, Aujla RK, Kirby AS, Moulton A, Webb JK (2002) The early detection of adolescent idiopathic scoliosis in three positions using the Scoliometer and real-time ultrasound: should the prone position also be used? In: Tanguy A, Peuchot B (eds) Research into spinal deformities. IOS Press/Ohmsha, Amsterdam/Tokyo, pp 381–385Google Scholar
  6. 6.
    Cote P, Kreitz BG, Cassidy JD, Dzus AK, Martel J (1998) A study of the diagnostic accuracy and reliability of the scoliometer and Adam`s foreward bending test. Spine 23:796–802PubMedCrossRefGoogle Scholar
  7. 7.
    Dickson RA, Weinstein SL (1999) Bracing (and screening)-yes or no? J Bone Joint Surg (Br) 81-B:193–198CrossRefGoogle Scholar
  8. 8.
    Drerup B, Hierholzer E (1992) Evaluation of frontal radiographs of scoliotic spines—Part I: Measurement of position and orientation of vertebra and assessment of clinical shape parameters. J Biomech 25:1357–1362PubMedCrossRefGoogle Scholar
  9. 9.
    Drerup B, Hierholzer E (1992) Evaluation of frontal radiographs of scoliotic spines—Part II: Relations between lateral deviation, lateral tilt and axial rotation of vertebrea. J Biomech 25:1443–1450PubMedCrossRefGoogle Scholar
  10. 10.
    Dunn BH, Hakala MW, McGee ME (1978) Scoliosis screening. Pediatrics 61:794–797PubMedGoogle Scholar
  11. 11.
    Goldberg CJ, Kaliszer M, Moore DP, Fogarty EE, Dowling FE (2001) Surface topography, Cobb angles, and cosmetic change in scoliosis. Spine 15:E55–E63CrossRefGoogle Scholar
  12. 12.
    Götze HG (1973) Der Rotationsindex bei idiopathischen Thorakalskoliosen. Z Orthop 111:737–743Google Scholar
  13. 13.
    Grossmann TW, Mazur JM, Cummings RJ (1995) An evolution of the Adams foreward bend test and the scoliometer in a scoliosis school screening setting. J Ped Orthop 15:535–538Google Scholar
  14. 14.
    Hierholzer E (1993) Objektive Analyse der Rückenform von Skoliosepatienten. Gustav Fischer, Stuttgart, New YorkGoogle Scholar
  15. 15.
    Hackenberg L, Hierholzer E, Pötzl W, Götze C, Liljenqvist U (2003) Rasterstereographic back shape analysis in idiopathic scoliosis after anterior correction and fusion. Clin Biomech 18:1–8CrossRefGoogle Scholar
  16. 16.
    Hackenberg L, Hierholzer E, Pötzl W, Götze C, Liljenqvist U (2003) Rasterstereographic back shape analysis in idiopathic scoliosis after posterior correction and fusion. Clin Biomech 18:883–889CrossRefGoogle Scholar
  17. 17.
    Johnson MR, Upadhyay SS, Burwell RG, Webb JK (1987) Integrated shape imaging system (ISIS) an evaluation of its capacity to measure lateral spine curves and appraise hump dynamics on forward flexion. J Bone Joint Surg 69-B:851–852Google Scholar
  18. 18.
    Karachalios T, Sofianos J, Roidis N, Sapkas G, Korres D, Nikolopoulos K (1999) Ten-year follow-up evaluation of a scool screening program for scoliosis. Is the forward-bending test an accurate diagnostic criterion for the screening of scoliosis? Spine 24(22):2318–2324PubMedCrossRefGoogle Scholar
  19. 19.
    Lonstein JE (1977) Screening for spinal deformities in Minnesota schools. Clin Orthop 126:33–42PubMedGoogle Scholar
  20. 20.
    Murell GAC, Coonrad RW, Moorman CT, Fitch RD (1993) An assesment of the reliability of the scoliometer. Spine 18:709–712CrossRefGoogle Scholar
  21. 21.
    Pearsall DJ, Reid GJ, Hedden DM (1992) Comparison of three non-invasive methods for measuring scoliosis. Phys Ther 72:648–657PubMedGoogle Scholar
  22. 22.
    Sakka SA, Wojcik A, Macindoe S, Metha MH (1995) Reproducibility and reliabilityof the quantec surface imaging system in the assessment of spinal deformity. In: D´Amico M, Merolli A, Santambrogio GC (eds) Three-dimensional analysis of spinal deformities. IOS Press/Omsha, Amsterdam/Tokyo, pp 441–445Google Scholar
  23. 23.
    Stokes IA, Moreland MS (1987) Measurement of the shape of the surface of the back in patients with idiopathic scoliosis. The standing and foreward-bending position. J Bone Joint Surg 69:203–211PubMedGoogle Scholar
  24. 24.
    Torell G, Nordwall A, Nachemson A (1981) The changing pattern of scoliosis treatment due to effective screening. J Bone Joint Surg 63-A:337–341Google Scholar
  25. 25.
    Turner-Smith AR, Harris JD, Houghton GR, Jefferson RJ (1988) A method for analysis of back shape in scoliosis. J Biomech 21:497–509PubMedCrossRefGoogle Scholar
  26. 26.
    Upadhyay SS, Burwell RG, Webb JK (1987) The use of the Scoliometer to valuate hump dynamics in relation to leg length in equality and pelvic tilt. J Bone Joint Surg 69B:851Google Scholar
  27. 27.
    Yawn BP, Yawn RA (2000) The estimated cost of school scoliosis screening. Spine 25:2387–2391PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Lars Hackenberg
    • 1
  • Eberhard Hierholzer
    • 1
  • Viola Bullmann
    • 1
  • Ulf Liljenqvist
    • 1
  • Christian Götze
    • 1
  1. 1.Klinik und Poliklinik für Allgemeine OrthopädieUniversitätsklinik MünsterMunsterGermany

Personalised recommendations