Skip to main content

Advertisement

SpringerLink
Log in

Intra- and Interobserver Reliability of the Cobb AngleeVertebral Rotation Angle—Spinous Process Angle for Adolescent Idiopathic Scoliosis

  • Validation Studies
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

A reliability analysis of Cobb angle, vertebral rotation (VR), and spinous process angle (SPA) measurements in adolescent idiopathic scoliosis.

Objective

To determine the intra- and interobserver reliability of semi-automated digital radiograph measurements.

Summary of Background Data

Cobb angle measurements on posteroanterior radiographs are commonly used to determine the severity of scoliosis. Vertebral rotation helps assess scoliosis 3-dimensionally and has a role in predicting curve progression. Recent studies have shown that the spinous process angle is a useful parameter in assessing scoliosis when using ultrasound imaging. Because the reliability of SPA measurements on radiographs has yet to be determined, it is important to compare the reliability of these 3 parameters (Cobb angle, VR, and SPA) using a computer assisted semi-automated method.

Methods

Sixty posteroanterior radiographs of patients with adolescent idiopathic scoliosis were obtained and measured twice by 3 observers who were blinded to their previous measurements, using an in-house developed program. Measurements were obtained using a semi-automated method to minimize variability resulting from observer reliability. The intra- and interobserver reliabilities were analyzed using intra-class correlation coefficients (ICCs) as well as BlandeAltman’s bias and limits of agreement.

Results

Over 350 (intra) and 90 (inter) sets of curves with an average Cobb angle of 26° ± 9° (range, 10° to 44°) were compared for each parameter. Intra-observer reliabilities for each parameter were excellent (ICC[2,1],.82; 1.00), with mean absolute differences under 3° between most measurements. Interobserver reliability (ICC[2,1],.72;.95) was mostly good to excellent, with mean absolute differences ranging from 2.0° to 5.6°.

Conclusions

Both the intra- and interobserver assessment of the Cobb, VR, and SPA from the semi-automated measurements had clinically acceptable reliability ranges and may be considered for clinical implementation. Additional studies will be conducted to determine the accuracy and sensitivity to change of these scoliosis severity measurements.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Tanure MC, Pinheiro AP, Oliveira AS. Reliability assessment of Cobb angle measurements using manual and digital methods. Spine J 2010;10:769–74.

    Article  Google Scholar 

  2. Zhang J, Lou E, Hill D, et al. Computer-aided assessment of scoliosis on posteroanterior radiographs. Med Biol Eng Comput 2010;48:185–95.

    Article  Google Scholar 

  3. Gstoettner M, Sekyra K, Walochnik N, et al. Inter- and intraobserver reliability assessment of the Cobb angle: manual versus digital measurement tools. Eur Spine J 2007;16:1587–92.

    Article  Google Scholar 

  4. Kuklo TR, Potter BK, O’Brien MF, et al. Reliability analysis for digital adolescent idiopathic scoliosis measurements. J Spinal Disord Tech 2005;18:15–9.

    Article  Google Scholar 

  5. Wills BP, Auerbach JD, Zhu X, et al. Comparison of Cobb angle measurement of scoliosis radiographs with preselected end vertebrae: traditional versus digital acquisition. Spine (Phila Pa 1976) 2007;32:98–105.

    Article  Google Scholar 

  6. Chen YL, Chen WJ, Chiou WK. An alternative method for measuring scoliosis curvature. Orthopedics 2007;30:828–31.

    Article  Google Scholar 

  7. Stokes IAF, Aronsson DD. Computer-assisted algorithms improve reliability of King classification and Cobb angle measurement of scoliosis. Spine (Phila Pa 1976) 2006;31:665–70.

    Article  Google Scholar 

  8. Allen S, Parent E, Khorasani M, et al. Validity and reliability of active shape models for the estimation of Cobb angle in patients with adolescent idiopathic scoliosis. J Digit Imaging 2008;21:208–18.

    Article  Google Scholar 

  9. Mok JM, Berven SH, Diab M, et al. Comparison of observer variation in conventional and three digital radiographic methods used in the evaluation of patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2008;33:681–6.

    Article  Google Scholar 

  10. Lonstein JE, Carlson JM. The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am 1984;66:1061–71.

    Article  CAS  Google Scholar 

  11. Drerup B. Principles of measurement of vertebral rotation from frontal projections of the pedicles. J Biomech 1984;17:923–35.

    Article  CAS  Google Scholar 

  12. Kuklo T, Potter BK, Lawrence L. Vertebral rotation and thoracic torsion in adolescent idiopathic scoliosis: what is the best radiographic correlate? J Spinal Disord Tech 2005;18:139–47.

    Article  Google Scholar 

  13. Perdriolle R, Vidal J. Thoracic idiopathic scoliosis curve evolution and prognosis. Spine (Phila Pa 1976) 1985;10:785–91.

    Article  CAS  Google Scholar 

  14. Weinstein SL, Ponseti I. Curve progression in idiopathic scoliosis. J Bone Joint Surg Am 1983;65:447–55.

    Article  CAS  Google Scholar 

  15. Heidari B, Fitzpatrick D, McCormack D, et al. Correlation of an induced rotation model with the clinical categorisation of scoliotic deformity—a possible platform for prediction of scoliosis progression. Stud Health Technol Inform 2006; 123:169.

    PubMed  Google Scholar 

  16. Cheung J, Veldhuizen AG, Haiberts JP, et al. Geometric and electromyographic assessments in the evaluation of curve progression in idiopathic scoliosis. Spine (Phila Pa 1976) 2006;31:322–9.

    Article  Google Scholar 

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

    Article  Google Scholar 

  18. Sugimoto Y, Tanaka M, Nakanishi K, et al. Predicting intraoperative vertebral rotation in patients with scoliosis using posterior elements as anatomical landmarks. Spine (Phila Pa 1976) 2007;32:761–3.

    Article  Google Scholar 

  19. Krawczyński A, Kotwicki T, Szulc A, et al. Clinical and radiological assessment of vertebral rotation in idiopathic scoliosis. Ortop Traumatol Rehabil 2006;8:602.

    PubMed  Google Scholar 

  20. Stokes IAF, Bigalow LC, Moreland MS. Measurement of axial rotation of vertebrae in scoliosis. Spine (Phila Pa 1976) 1986;11:213–8.

    Article  CAS  Google Scholar 

  21. Nash CL, Moe J. A study of vertebral rotation. J Bone Joint Surg Am 1969;51:223–9.

    Article  Google Scholar 

  22. Perdriolle R, Vidal J. Thoracic idiopathic scoliosis curve evaluation and prognosis. Spine (Phila Pa 1976) 1985;10:785–91.

    Article  CAS  Google Scholar 

  23. Herzenberg JE, Waanders NA, Closkey RF, et al. Cobb angle versus spinous process angle in adolescent idiopathic scoliosis the relationship of the anterior and posterior deformities. Spine (Phila Pa 1976) 1990;15:874–9.

    Article  CAS  Google Scholar 

  24. Chen W, Le L, Lou E. Ultrasound imaging of spinal vertebrae to study scoliosis. Open J Acoust 2012;2:95–103.

    Article  CAS  Google Scholar 

  25. Li M, Cheng J, Ying M, et al. Application of 3-D ultrasound in assisting the fitting procedure of spinal orthosis to patients with adolescent idiopathic scoliosis. Stud Health Technol Inform 2010;158:34–7.

    CAS  PubMed  Google Scholar 

  26. Li M, Cheng J, Ying M, et al. Could clinical ultrasound improve the fitting of spinal orthosis for the patients with AIS? Eur Spine J 2012;21:1926–35.

    Article  CAS  Google Scholar 

  27. Suzuki S, Yamamuro T, Shikata J, et al. Ultrasound measurement of vertebral rotation in idiopathic scoliosis. J Bone Joint Surg Br 1989;7:252–5.

    Article  Google Scholar 

  28. Chen W, Lou EH, Zhang PQ, et al. Reliability of assessing the coronal curvature of children with scoliosis by using ultrasound images. J Pediatr Orthop 2013:1–9.

    Google Scholar 

  29. Portney LG, Watkins MP. Foundations of clinical research. New Jersey: Pearson/Prentice Hall; 1993.

    Google Scholar 

  30. Currier P. Elements of research in physical therapy. Baltimore: Williams & Wilkins; 1990.

    Google Scholar 

  31. Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res 1999;8:135–60.

    Article  CAS  Google Scholar 

  32. Stratford PW, Goldsmith CH. Use of the standard error as a reliability index of interest: an applied example using elbow flexor strength data. Phys Ther 1997;77:745–50.

    Article  CAS  Google Scholar 

  33. Pinheiro AP, Tanure MC, Oliveira AS. Validity and reliability of a computer method to estimate vertebral axial rotation from digital radiographs. Eur Spine J 2010;19:415–20.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Alberta, 2D, Walter C Mackenzie Health Sciences Centre, 8440 - 112 Street, Edmonton, T6G 2B7, Canada

    Amanda C. Y. Chan, Devlin G. Morrison, Duc V. Nguyen, Douglas L. Hill MBA & Edmond H. M. Lou PhD

  2. Schulich School of Engineering, University of Calgary, 2500 University Drive NW, Calgary, T2N 1N4, Canada

    Amanda C. Y. Chan

  3. Department of Electrical and Computer Engineering, University of Alberta, 2nd Floor, ECERF, 9107 - 116 Street, Edmonton, T6G 2V4, Canada

    Devlin G. Morrison & Edmond H. M. Lou PhD

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

    Douglas L. Hill MBA & Edmond H. M. Lou PhD

  5. Department of Physical Therapy, University of Alberta, 8205 114 St, 2–50 Corbett Hall, Edmonton, T6G 2G4, Canada

    Eric Parent PhD

  6. Glenrose Rehabilitation Research Centre, 10105 112 Avenue, Edmonton, AB, T5G 0H1, Canada

    Edmond H. M. Lou PhD

Authors
  1. Amanda C. Y. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Devlin G. Morrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Duc V. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Douglas L. Hill MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eric Parent PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Edmond H. M. Lou PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edmond H. M. Lou PhD.

Additional information

Author disclosures: ACYC (none); DGM (none); DVN (none); DLH (none); EP (none); EHM L (none).

This work was supported by the Alberta Innovates Health Solutions, Women’s and Children’s Health Research Institute.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chan, A.C.Y., Morrison, D.G., Nguyen, D.V. et al. Intra- and Interobserver Reliability of the Cobb AngleeVertebral Rotation Angle—Spinous Process Angle for Adolescent Idiopathic Scoliosis. Spine Deform 2, 168–175 (2014). https://doi.org/10.1016/j.jspd.2014.02.006

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2014.02.006

Keywords

Search

Navigation