European Spine Journal

, Volume 25, Issue 10, pp 3137–3145 | Cite as

Characterizing the differences between the 2D and 3D measurements of spine in adolescent idiopathic scoliosis

  • Saba PashaEmail author
  • Patrick J. Cahill
  • John P. Dormans
  • John M. Flynn
Original Article



Although adolescent idiopathic scoliosis (AIS) is known to impact the 3D orientation of the spine and pelvis, the impact of the vertebral position relative to the X-ray scanner on the agreement between 2D and 3D measurements of a curve has not been evaluated. The purpose of this study was to investigate the agreement between 2D and 3D measurements of the scoliotic curve as a function of the 3D spinal parameters in AIS.


Three independent observers measured the thoracic and lumbar Cobb angles, Kyphosis, and lordosis on the posterior–anterior and lateral X-rays of AIS patients. The 3D reconstructions were created from bi-planar X-rays and the 3D spinal parameters were calculated in both radio and patient planes using SterEOS software. The degree of agreement between the 2D and 3D measurements was tested and its relationship with the curve axial rotation was determined.


2D and 3D measurements of the sagittal plane spinal parameters were significantly different (p < 0.05). The differences between the 2D and 3D measurements were related to the apical vertebrae rotation, the orientation of the plane of maximum curvature, pelvic axial rotation, and the curve magnitude. Differences between the radio plane and patient plane measurements were related to the pelvic axial rotation, Cobb angles, and apical vertebrae rotation, p < 0.05.


Clinically and statistically significant differences were observed between the 2D and 3D measurements of the scoliotic spine. The differences between the 2D and 3D techniques were significant in sagittal plane and were related to the spinal curve and pelvic rotation in transverse plane.


Adolescent idiopathic scoliosis Spine 3D reconstruction Axial rotation Interrater reliability 


Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Saba Pasha
    • 1
    Email author
  • Patrick J. Cahill
    • 1
  • John P. Dormans
    • 2
  • John M. Flynn
    • 1
  1. 1.Division of Orthopaedic SurgeryThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Pediatric Orthopaedic SurgeryTexas Children’s HospitalHoustonUSA

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