What is the role of radiography in the workup of idiopathic scoliosis?

Updated: Dec 02, 2020
  • Author: Charles T Mehlman, DO, MPH; Chief Editor: Jeffrey A Goldstein, MD  more...
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Multiple authors have cited the value of bending radiographs, including those over a fulcrum. [63] Klepps and Lenke et al found that thoracic fulcrum bending radiographs worked best for them when dealing with isolated main thoracic curves. [64]

After the publication of the King classification in the early 1980s, the thoracic curve patterns found in adolescent idiopathic scoliosis (see the images below) were commonly classified according to this system. [65] Subsequently, significant questions were raised regarding its reliability and reproducibility. [66, 67] In addition, it was noted that the King classification alone (in its original form) does not allow comprehensive curve classification (eg, lumbar and thoracolumbar curve patterns). [68]  Many now regard the King classification as primarily of historical interest. The Lenke classification has become more commonly used for adolescent idiopathic scoliosis. [69]

Mild juvenile scoliosis. Mild juvenile scoliosis.
Anteroposterior (AP) radiograph shows mild adolesc Anteroposterior (AP) radiograph shows mild adolescent scoliosis.
Lateral view of mild adolescent scoliosis. Lateral view of mild adolescent scoliosis.
Moderate scoliosis. Moderate scoliosis.

Multiple authors have analyzed the ability of orthopedic surgeons to reliably measure scoliosis radiographs. Morrissy et al used 50 radiographs and four examiners (two experienced orthopedic surgeons, one fellow, one senior resident) to study their ability to make Cobb angle measurements. With the examiners choosing end vertebrae and measuring scoliotic curves accordingly, intraobserver variability was 4.9°. [70]

Carman et al used eight scoliosis radiographs measured by five examiners (four orthopedic surgeons, one physical therapist) to evaluate interobserver and intraobserver variation. They found that a 10° measurement difference is necessary before there is a 95% confidence level that one Cobb angle measurement is truly different from another. [71]

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