Skip to main content
Log in

Cobb angle measurement with a conventional convex echography probe and a smartphone

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

Abstract

Background context

Serial X-rays are needed during the follow-up of adolescent idiopathic scoliosis. They are done every 6 or 3 months in cases of high risk of progression. Thanks to the advances in ultrasound techniques, deformity measurement systems free from ionizing radiations have been validated, although spinal surgeons did not use them routinely due to the need of special software.

Objective

The aim of our work is to assess the reproducibility and correlation of an ultrasound measuring system based on the positioning of the transverse processes.

Study design

Prospective, single center, randomized, triple blinded.

Methods

Two independent researchers trained in ultrasound examined the spinal deformities of 31 children. The measurements were compared against those performed with an X-ray by three scoliosis expert surgeons. Statistics were performed by an independent researcher. Parametric methods were used.

Results

We found a 95% [(0.91–0.97) p < 2.2e−16] correlation between the degree of scoliosis measured with the proposed ultrasound system and the 30 cm × 90 cm X-rays in standing position. There was an intra-observer reliability of 97% [r-squared = 0.97; CI 95% (0.95–0.98) p < 2.2e−16] and an inter-observer reliability of 95% [r-squared = 0.95; CI 95% (0.90–0.97) p < 2.2e−16].

Conclusions

An approximation of the Cobb angle measure is possible with ultrasound by using the transverse processes as reference. This is a very rapid and simple system for assessing the principal spinal deformity measure in young people, although it does not allow estimating the associated axial or sagittal rotation.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /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.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Kamtsiuris P, Atzpodien K, Ellert U, Schlack R, Schlaud M (2007) Prevalence of somatic diseases in German children and adolescents. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt Gesundh Gesundh 50(5–6):686–700

    Article  CAS  Google Scholar 

  2. Konieczny MR, Senyurt H, Krauspe R (2013) Epidemiology of adolescent idiopathic scoliosis. J Child Orthop 7(1):3–9

    Article  PubMed  Google Scholar 

  3. Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC et al (2018) 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord 13:3

    Article  PubMed  PubMed Central  Google Scholar 

  4. Uno H, Wei L-J, Hughes M (2014) Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 370(7):680

    Article  PubMed  Google Scholar 

  5. Negrini S, Negrini F, Fusco C, Zaina F (2011) Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements. Spine J 11(5):369–380

    Article  PubMed  Google Scholar 

  6. Lenke LG (2005) Lenke classification system of adolescent idiopathic scoliosis: treatment recommendations. Instr Course Lect 54:537–542

    PubMed  Google Scholar 

  7. Terran J, Schwab F, Shaffrey CI, Smith JS, Devos P, Ames CP et al (2013) The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 73(4):559–568

    Article  PubMed  Google Scholar 

  8. Trobisch PD, Ducoffe AR, Lonner BS, Errico TJ (2013) Choosing fusion levels in adolescent idiopathic scoliosis. J Am Acad Orthop Surg 21(9):519–528

    PubMed  Google Scholar 

  9. El-Hawary R, Chukwunyerenwa C (2014) Update on evaluation and treatment of scoliosis. Pediatr Clin N Am 61(6):1223–1241

    Article  Google Scholar 

  10. Lonstein JE, Carlson JM (1984) The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am 66(7):1061–1071

    Article  CAS  PubMed  Google Scholar 

  11. Knott P, Pappo E, Cameron M, Demauroy J, Rivard C, Kotwicki T et al (2014) SOSORT 2012 consensus paper: reducing X-ray exposure in pediatric patients with scoliosis. Scoliosis 9:4

    Article  PubMed  PubMed Central  Google Scholar 

  12. Jada A, Mackel CE, Hwang SW, Samdani AF, Stephen JH, Bennett JT et al (2017) Evaluation and management of adolescent idiopathic scoliosis: a review. Neurosurg Focus 43(4):E2

    Article  PubMed  Google Scholar 

  13. Law M, Ma W-K, Lau D, Chan E, Yip L, Lam W (2016) Cumulative radiation exposure and associated cancer risk estimates for scoliosis patients: impact of repetitive full spine radiography. Eur J Radiol 85(3):625–628

    Article  PubMed  Google Scholar 

  14. Presciutti SM, Karukanda T, Lee M (2014) Management decisions for adolescent idiopathic scoliosis significantly affect patient radiation exposure. Spine J 14(9):1984–1990

    Article  PubMed  Google Scholar 

  15. Newton PO, Khandwala Y, Bartley CE, Reighard FG, Bastrom TP, Yaszay B (2016) New EOS imaging protocol allows a substantial reduction in radiation exposure for scoliosis patients. Spine Deform 4(2):138–144

    Article  PubMed  Google Scholar 

  16. Morel B, Moueddeb S, Blondiaux E, Richard S, Bachy M, Vialle R et al (2018) Dose, image quality and spine modeling assessment of biplanar EOS micro-dose radiographs for the follow-up of in-brace adolescent idiopathic scoliosis patients. Eur Spine J 27(5):1082–1088

    Article  PubMed  Google Scholar 

  17. Khodaei M, Hill D, Zheng R, Le LH, Lou EHM (2018) Intra- and inter-rater reliability of spinal flexibility measurements using ultrasonic (US) images for non-surgical candidates with adolescent idiopathic scoliosis: a pilot study. Eur Spine J 27:2156–2164

    Article  PubMed  Google Scholar 

  18. Zheng Y-P, Lee TT-Y, Lai KK-L, Yip BH-K, Zhou G-Q, Jiang W-W et al (2016) A reliability and validity study for Scolioscan: a radiation-free scoliosis assessment system using 3D ultrasound imaging. Scoliosis Spinal Disord 11:13

    Article  PubMed  PubMed Central  Google Scholar 

  19. Oxborrow NJ (2000) Assessing the child with scoliosis: the role of surface topography. Arch Dis Child 83(5):453–455

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Knott P, Mardjetko S, Nance D, Dunn M (2006) Electromagnetic topographical technique of curve evaluation for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 31(24):E911–E915 (discussion E916)

    Article  Google Scholar 

  21. Chen W, Le LH, Lou EHM (2012) Ultrasound imaging of spinal vertebrae to study scoliosis. Open J Acoust 2(3):95–103

    Article  CAS  Google Scholar 

  22. Homans J (2018) How do different ultrasound measurements of the scoliotic spine relate to the Cobb angle? A CT based study? In: Global spine congress

  23. Fleiss L, Cohen J (1973) The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas 33:613

    Article  Google Scholar 

  24. McHugh ML (2012) Interrater reliability: the kappa statistic. Biochem Med 22(3):276–282

    Article  Google Scholar 

  25. Villemure I, Aubin CE, Grimard G, Dansereau J, Labelle H (2001) Progression of vertebral and spinal three-dimensional deformities in adolescent idiopathic scoliosis: a longitudinal study. Spine (Phila Pa 1976) 26(20):2244–2250

    Article  CAS  Google Scholar 

  26. White AA 3rd (1971) Kinematics of the normal spine as related to scoliosis. J Biomech 4(5):405–411

    Article  PubMed  Google Scholar 

  27. Morrison DG, Chan A, Hill D, Parent EC, Lou EHM (2015) 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(2):306–312

    Article  PubMed  Google Scholar 

  28. Naziri Q, Detolla J, Hayes W, Burekhovich S, Merola A, Akamnanu C et al (2018) A systematic review of all smart phone applications specifically aimed for use as a scoliosis screening tool. J Long Term Eff Med Implants 28(1):25–30

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Special mention to Isabel Llorenç and to Teresa Rodríguez for their ideas and commitment to the project.

Funding

The study was approved by the Medical Ethics Committee of the institution (2017/0619).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joan Ferràs-Tarragó.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 448 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferràs-Tarragó, J., Valencia, J.M.M., Belmar, P.R. et al. Cobb angle measurement with a conventional convex echography probe and a smartphone. Eur Spine J 28, 1955–1961 (2019). https://doi.org/10.1007/s00586-019-06030-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-019-06030-0

Keywords

Navigation