Skip to main content
SpringerLink
Log in

Correlation between Cobb angle, spinous process angle (SPA) and apical vertebrae rotation (AVR) on posteroanterior radiographs in adolescent idiopathic scoliosis (AIS)

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To investigate the accuracy and reliability of the Cobb angle, the spinous process angle (SPA), and apical vertebral rotation (AVR) for measuring adolescent idiopathic scoliosis (AIS), and to evaluate the correlations between these measurements.

Methods

A retrospective study of two sets of standing posteroanterior radiographs of patients with AIS was performed. The first set was 59 consecutive patients with AIS with Cobb angles <45° and the second set was 25 patients with Cobb angles >45°. The Cobb angle, SPA and AVR of each curve was measured twice by three observers with varying measurement experience. The mean absolute difference, standard deviation, and intra- and inter-rater reliability coefficients for each measurement were examined. The Pearson correlation coefficients between any two parameters were reported. The association of the Cobb angle with the SPA and AVR was examined using a multiple regression model.

Results

The average intra- and inter-observer reliabilities (ICC [2, 1]) of the Cobb angle, SPA, and AVR were 0.99, 0.95, 0.92 and 0.98, 0.88, 0.83, respectively. The correlation coefficients (r) between Cobb angle and SPA, Cobb angle and AVR, and SPA and AVR were 0.93, 0.68, and 0.60, respectively. Using multiple regression, the association between the Cobb angle and SPA combined with AVR was R 2 = 0.90. The resulting regression model was: \({\text{Cobb angle}} = 4.1 + 0.88 \times {\text{SPA}} + 0.44 \times {\text{AVR}}\).

Conclusion

The SPA has high correlation with the Cobb angle. Including the AVR as an additional factor in multiple regression improves the prediction of the Cobb angle.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

References

  1. Cobb JR (1948) Outline for the study of scoliosis. Am Acad Othop Surg Inst Course Lect 5:261–275

    Google Scholar 

  2. Herzenberg JE, Waanders NA, Closkey RF et al (1990) Cobb angle versus spinous process angle in adolescent idiopathic scoliosis. The relationship of the anterior and posterior deformities. Spine 15(9):874–879

    Article  CAS  PubMed  Google Scholar 

  3. Illes T, Somoskeoy S (2013) Comparison of scoliosis maesurements based on three-dimensional vertebra vectors and conventional two-dimensional measurements: advantages in evaluation of prognosis and surgical results. Eur Spine J 22(6):1255–1263

    Article  PubMed Central  PubMed  Google Scholar 

  4. Lam GC, Hill DL, Le LH et al (2008) Vertebral rotation measurement: a summary and comparison of common radiographic and CT methods. Scoliosis 3:16

    Article  PubMed Central  PubMed  Google Scholar 

  5. Li M, Cheng J, Ying M et al (2010) Application of 3-D ultrasound in assisting the fitting procedure of spinal orthosis to patients with adolescent idiopathic scoliosis. Stud Health Technol Inform 158:34–37

    CAS  PubMed  Google Scholar 

  6. Li M, Cheng J, Ying M et al (2012) Could clinical ultrasound improve the fitting of spinal orthosis for the patients with AIS? Eur Spine J 21(10):1926–1935

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Lonstein JE (1994) Adolescent idiopathic scoliosis. Lancet 344:1407–1412

    Article  CAS  PubMed  Google Scholar 

  8. Lonstein JE, Carlson JM (1984) The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg (Am) 66(7):1056–1060

    Google Scholar 

  9. Malfair D, Flemming AK, Cvorak MF et al (2010) Radiographic evaluation of scoliosis: review. Am J Roentgenol 194(3):S8–S22

    Article  Google Scholar 

  10. Morrissy RT, Goldsmith GS, Hall EC et al (1990) Measurement of the Cobb angle on radiographs of patients who have scoliosis. Evaluation of intrinsic error. J Bone Joint Surg (Am) 72(3):320–327

    CAS  Google Scholar 

  11. Pruijs JEH, Hageman MAPE, Keessen W et al (1994) Variation in Cobb angle measurements in scoliosis. Skeletal Radiol 23(7):517–520

    Article  CAS  PubMed  Google Scholar 

  12. Stokes IA, Bigalow LC, Moreland MS (1986) Measurement of axial rotation of vertebrae in scoliosis. Spine 11(3):213–218

    Article  CAS  PubMed  Google Scholar 

  13. Stokes IA (1989) Axial rotation component of thoracic scoliosis. J Orthop Res 7(5):702–708

    Article  CAS  PubMed  Google Scholar 

  14. Suzuki S, Yamamuro T, Shimizu K et al (1989) Ultrasound measurement of vertebral rotation in idiopathic scoliosis. J Bone Joint Surg (Br) 71(2):252–255

    CAS  Google Scholar 

  15. Vieira RR, Arora R, Schweitzer ME (2009) Radiologic imaging of spinal deformities. In: Errico TJ, Lonner BS, Moulton AW (eds) Surgical management of spinal deformities, 1st edn. Elsevier, Philadelphia, pp 45–59

    Chapter  Google Scholar 

  16. Villemure A, Aubin CE, Grimard G et al (2001) Progression of vertebral and spinal three-dimensional deformities adolescent idiopathic scoliosis. Spine 26(20):2244–2250

    Article  CAS  PubMed  Google Scholar 

  17. Zhang J, Lou E, Hill DL et al (2010) Computer-aided assessment of scoliosis on posteroanterior radiographs. Med Biol Eng Comput 48:185–195

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported through funding provided by Natural Sciences and Engineering Research Council of Canada. The software used in this study to analyze digital radiographs was developed by Duc V. Nguyen, Department of Surgery, University of Alberta, Edmonton, AB T6G 2R3, Canada.

Conflict of interest

The authors declare that they do not have any conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Alberta, Edmonton, AB, T6G 2B7, Canada

    Devlin G. Morrison, Amanda Chan, Doug Hill, Eric C. Parent & Edmond H. M. Lou

  2. Research and Technology Development, Alberta Health Services-Glenrose Rehabilitation Hospital, 10230-111 Ave, Edmonton, AB, T5G 0B7, Canada

    Doug Hill & Edmond H. M. Lou

  3. Department of Physical Therapy, University of Alberta, Edmonton, AB, T6G 2G4, Canada

    Eric C. Parent

Authors
  1. Devlin G. Morrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amanda Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Doug Hill
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric C. Parent
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Edmond H. M. Lou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edmond H. M. Lou.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morrison, D.G., Chan, A., Hill, D. et al. Correlation between Cobb angle, spinous process angle (SPA) and apical vertebrae rotation (AVR) on posteroanterior radiographs in adolescent idiopathic scoliosis (AIS). Eur Spine J 24, 306–312 (2015). https://doi.org/10.1007/s00586-014-3684-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-014-3684-1

Keywords

Search

Navigation