Advertisement

European Spine Journal

, Volume 22, Issue 11, pp 2360–2371 | Cite as

Measuring procedures to determine the Cobb angle in idiopathic scoliosis: a systematic review

  • S. Langensiepen
  • O. Semler
  • R. Sobottke
  • O. Fricke
  • J. Franklin
  • E. Schönau
  • P. Eysel
Review Article

Abstract

Background

Scoliosis of the vertebral column can be assessed with the Cobb angle (Cobb 1948). This examination is performed manually by measuring the angle on radiographs and is considered the gold standard. However, studies evaluating the reproducibility of this procedure have shown high variability in intra- and inter-observer agreement. Because of technical advancements, interests in new procedures to determine the Cobb angle has been renewed. This review aims to systematically investigate the reproducibility of various new techniques to determine the Cobb angle in idiopathic scoliosis and to assess whether new technical procedures are reasonable alternatives when compared to manual measurement of the Cobb angle.

Method

Systematic review. Studies examining procedures used to determine the Cobb angle were selected. Two review authors independently selected studies for inclusion, extracted data and assessed risk of bias. Statistical results of reliability and agreement were summarised and described.

Results

Eleven studies of new measuring procedures were included, all reporting the reproducibility. The new procedures can be divided into computer-assisted procedures, automatic procedures and smartphone apps.

Conclusions

All investigated measuring procedures showed high degrees of reliability. In general, digital procedures tend to be slightly better than manual ones. For all other measurement procedures (automatic or smartphone), results varied. Studies implementing vertebral pre-selection and observer training achieved better agreement.

Keywords

Cobb angle Idiopathic scoliosis Systematic review Reproducibility Measuring methods Computer-assisted measuring 

Abbreviations

D2L, D4L, D6L

Digital two, four or six landmarks

DH

Digital horizontal

A

Automatic

S

Smartphone

ICC

Intraclass Correlation

R

Correlation Coefficient

QUADAS

Quality Assessment of Diagnostic Accuracy Studies

QAREL

Quality Appraisal of Reliability Studies

NA

Not assessed

SD

Standard Deviation

SEM

Standard Error of Measurement

MAD

Mean Absolute Difference

CI

Confidence Interval

Notes

Conflict of interest

None.

References

  1. 1.
    Cobb JR (1948) Outline for the study of scoliosis. Am Acad Orthop Surg Instr Course Lect 5:261–275Google Scholar
  2. 2.
    Romano M, Minozzi S, Bettany-Saltikov J, Zaina F, Chockalingam N, Kotwicki T, Maier-Hennes A, Negrini S (2012) Exercises for adolescent idiopathic scoliosis. Cochrane Database Syst Rev 8:CD007837. doi: 10.1002/14651858.CD007837.pub2 PubMedGoogle Scholar
  3. 3.
    Negrini S, Minozzi S, Bettany-Saltikov J, Zaina F, Chockalingam N, Grivas TB, Kotwicki T, Maruyama T, Romano M, Vasiliadis ES (2010) Braces for idiopathic scoliosis in adolescents. Spine (Phila Pa 1976) 35(13):1285–1293. doi: 10.1097/BRS.0b013e3181dc48f4 Google Scholar
  4. 4.
    Morrissy RT, Goldsmith GS, Hall EC, Kehl D, Cowie GH (1990) Measurement of the Cobb angle on radiographs of patients who have scoliosis. Evaluation of intrinsic error. J Bone Joint Surg Am 72(3):320–327PubMedGoogle Scholar
  5. 5.
    Carman DL, Browne RH, Birch JG (1990) Measurement of scoliosis and kyphosis radiographs. Intraobserver and interobserver variation. J Bone Joint Surg Am 72(3):328–333PubMedGoogle Scholar
  6. 6.
    Srinivasalu S, Modi HN, Smehta S, Suh SW, Chen T, Murun T (2008) Cobb angle measurement of scoliosis using computer measurement of digitally acquired radiographs-intraobserver and interobserver variability. Asian Spine J 2(2):90–93. doi: 10.4184/asj.2008.2.2.90 PubMedCrossRefGoogle Scholar
  7. 7.
    Corona J, Sanders JO, Luhmann SJ, Diab M, Vitale MG (2012) Reliability of radiographic measures for infantile idiopathic scoliosis. J Bone Joint Surg Am 94(12):e861–e868. doi: 10.2106/JBJS.K.00311 Google Scholar
  8. 8.
    Jones JK, Krow A, Hariharan S, Weekes L (2008) Measuring angles on digitalized radiographic images using Microsoft PowerPoint. West Indian Med J 57(1):14–19PubMedGoogle Scholar
  9. 9.
    Tanure MC, Pinheiro AP, Oliveira AS (2010) Reliability assessment of Cobb angle measurements using manual and digital methods. Spine J 10(9):769–774. doi: 10.1016/j.spinee.2010.02.020 PubMedCrossRefGoogle Scholar
  10. 10.
    Shea KG, Stevens PM, Nelson M, Smith JT, Masters KS, Yandow S (1998) A comparison of manual versus computer-assisted radiographic measurement. Intraobserver measurement variability for Cobb angles. Spine (Phila Pa 1976) 23(5):551–555CrossRefGoogle Scholar
  11. 11.
    Cheung J, Wever DJ, Veldhuizen AG, Klein JP, Verdonck B, Nijlunsing R, Cool JC, Van Horn JR (2002) The reliability of quantitative analysis on digital images of the scoliotic spine. Eur Spine J 11(6):535–542. doi: 10.1007/s00586-001-0381-7 PubMedCrossRefGoogle Scholar
  12. 12.
    Chockalingam N, Dangerfield PH, Giakas G, Cochrane T, Dorgan JC (2002) Computer-assisted Cobb measurement of scoliosis. Eur Spine J 11(4):353–357. doi: 10.1007/s00586-002-0386-x PubMedCrossRefGoogle Scholar
  13. 13.
    Allen S, Parent E, Khorasani M, Hill DL, Lou E, Raso JV (2008) Validity and reliability of active shape models for the estimation of cobb angle in patients with adolescent idiopathic scoliosis. J Digit Imaging 21(2):208–218. doi: 10.1007/s10278-007-9026-7 PubMedCrossRefGoogle Scholar
  14. 14.
    Zhang J, Lou E, Hill DL, Raso JV, Wang Y, Le LH, Shi X (2010) Computer-aided assessment of scoliosis on posteroanterior radiographs. Med Biol Eng Comput 48(2):185–195. doi: 10.1007/s11517-009-0556-7 PubMedCrossRefGoogle Scholar
  15. 15.
    Shaw M, Adam CJ, Izatt MT, Licina P, Askin GN (2012) Use of the iPhone for Cobb angle measurement in scoliosis. Eur Spine J 21(6):1062–1068. doi: 10.1007/s00586-011-2059-0 PubMedCrossRefGoogle Scholar
  16. 16.
    Qiao J, Liu Z, Xu L, Wu T, Zheng X, Zhu Z, Zhu F, Qian B, Qiu Y (2012) Reliability analysis of a smartphone-aided measurement method for the Cobb angle of scoliosis. J Spinal Disord Tech 25(4):E88–E92. doi: 10.1097/BSD.0b013e3182463964 PubMedCrossRefGoogle Scholar
  17. 17.
    de Vet HC, Terwee CB, Knol DL, Bouter LM (2006) When to use agreement versus reliability measures. J Clin Epidemiol 59(10):1033–1039. doi: 10.1016/j.jclinepi.2005.10.015 PubMedCrossRefGoogle Scholar
  18. 18.
    Bartlett JW, Frost C (2008) Reliability, repeatability and reproducibility: analysis of measurement errors in continuous variables. Ultrasound Obstet Gynecol 31(4):466–475. doi: 10.1002/uog.5256 PubMedCrossRefGoogle Scholar
  19. 19.
    Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428PubMedCrossRefGoogle Scholar
  20. 20.
    Streiner DL, Norman GR (2008) Health measurement scales a practical guide to their development and use, vol 4. Oxford University Press, OxfordGoogle Scholar
  21. 21.
    Whiting P, Rutjes AW, Dinnes J, Reitsma J, Bossuyt PM, Kleijnen J (2004) Development and validation of methods for assessing the quality of diagnostic accuracy studies. Health Technol Assess 8(25):1–234 (pii: 98-27-99)Google Scholar
  22. 22.
    Lucas NP, Macaskill P, Irwig L, Bogduk N (2010) The development of a quality appraisal tool for studies of diagnostic reliability (QAREL). J Clin Epidemiol 63(8):854–861. doi: 10.1016/j.jclinepi.2009.10.002 PubMedCrossRefGoogle Scholar
  23. 23.
    Zhang J, Lou E, Le LH, Hill DL, Raso JV, Wang Y (2009) Automatic Cobb measurement of scoliosis based on fuzzy Hough transform with vertebral shape prior. J Digit Imaging 22(5):463–472. doi: 10.1007/s10278-008-9127-y PubMedCrossRefGoogle Scholar
  24. 24.
    Zhang J, Lou E, Shi X, Wang Y, Hill DL, Raso JV, Le LH, Lv L (2010) A computer-aided Cobb angle measurement method and its reliability. J Spinal Disord Tech 23(6):383–387. doi: 10.1097/BSD.0b013e3181bb9a3c PubMedCrossRefGoogle Scholar
  25. 25.
    Goldberg MS, Poitras B, Mayo NE, Labelle H, Bourassa R, Cloutier R (1988) Observer variation in assessing spinal curvature and skeletal development in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 13(12):1371–1377CrossRefGoogle Scholar
  26. 26.
    Lonstein JE, Carlson JM (1984) The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am 66(7):1061–1071PubMedGoogle Scholar
  27. 27.
    Pruijs JE, Hageman MA, Keessen W, van der Meer R, van Wieringen JC (1994) Variation in Cobb angle measurements in scoliosis. Skeletal Radiol 23(7):517–520PubMedCrossRefGoogle Scholar
  28. 28.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • S. Langensiepen
    • 1
  • O. Semler
    • 2
  • R. Sobottke
    • 3
  • O. Fricke
    • 2
  • J. Franklin
    • 4
  • E. Schönau
    • 2
  • P. Eysel
    • 5
  1. 1.Unireha, Paediatric RehabilitationUniversity of CologneCologneGermany
  2. 2.Children’s HospitalUniversity of CologneCologneGermany
  3. 3.Center for Orthopaedic and Trauma Surgery, Department of OrthopaedicsMedizinisches Zentrum StädteRegion AachenWürselenGermany
  4. 4.Institute of Medical Statistics, Informatics and EpidemiologyUniversity of CologneCologneGermany
  5. 5.Department of Orthopaedic and Trauma SurgeryUniversity of CologneCologneGermany

Personalised recommendations