Document Type: Original Research

Authors

1 MSc, Escuela Superior Politécnica del Chimborazo, Riobamba, Chimborazo, Ecuador

2 MEng, Escuela Superior Politécnica del Chimborazo, Riobamba, Chimborazo, Ecuador

3 MD, Hospital del IESS “Guasmo Sur”, Guayaquil, Guayas, Ecuador

4 MEng, Universidad Técnica de Ambato, Ambato, Tungurahua, Ecuador

5 MSc, Independent Researcher, Ambato, Tungurahua, Ecuador

6 MPT, Universidad Nacional del Chimborazo, Riobamba, Chimborazo, Ecuador

7 PhD, The 2nd Affiliated Hospital &Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

8 MD, The 2nd Affiliated Hospital &Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

10.31661/jbpe.v0i0.1194

Abstract

Background: Scoliosis is a health problem that causes a side-to-side curvature in the spine. The curvature may have an “S” or “C” shape. To evaluate scoliosis, the Cobb angle has been commonly used. However, digital image processing allows the Cobb angle to be obtained easily and quickly, several researchers have determined that Cobb angle contains high variations (errors) in the measurements. Therefore, a more reproducible computer aided-method to evaluate scoliosis is presented.
Material and Methods: In this analytical study, several polynomial curves were fitted to the spine curvature (4th to 8th order) of thirty plain films of scoliosis patients to obtain the Curvature-Length of the spine. Each plain film was evaluated by 3 physician observers. Curvature was measured twice using the Cobb method and the proposed Curvature-Length Technique (CLT). Data were analyzed by a paired-sample Student t-test and Pearson correlation method using SPSS Statistics 25.
Results: The curve of 7th order polynomial had the best fit on the spine curvature and was also used for our proposed method (CLT) obtaining a significant positive correlation when compared to Cobb measurements (r=0.863, P<0.001). The Intraclass Correlation (ICC) was between 0.863 and 0.948 for Cobb method and0.974 to 0.984 for CLT method. In addition, mean measurement of the inter-observer COV (Coefficient of Variation) for Cobb method was of 0.185, that was significantly greater than the obtained with CLT method of 0.155, this means that CLT method is 16.2% more repeatable than Cobb Method.
Conclusion: Based on results, it was concluded that CLT method is more reproducible than the Cobb method for measuring spinal curvature.

Keywords

  1. Romano M, Minozzi S, Zaina F, Saltikov JB, Chockalingam N, Kotwicki T, et al. Exercises for adolescent idiopathic scoliosis: a Cochrane systematic review. Spine (Phila Pa 1976). 2013;38:E883-93. doi: 10.1097/BRS.0b013e31829459f8. PubMed PMID: 23558442.
  2. Qiao J, Liu Z, Xu L, Wu T, Zheng X, Zhu Z, et al. Reliability analysis of a smartphone-aided measurement method for the Cobb angle of scoliosis. J Spinal Disord Tech. 2012;25:E88-92. doi: 10.1097/BSD.0b013e3182463964. PubMed PMID: 22237178.
  3. Langensiepen S, Semler O, Sobottke R, Fricke O, Franklin J, Schonau E, et al. Measuring procedures to determine the Cobb angle in idiopathic scoliosis: a systematic review. Eur Spine J. 2013;22:2360-71. doi: 10.1007/s00586-013-2693-9. PubMed PMID: 23443679; PubMed Central PMCID: PMCPMC3886494.
  4. Wu W, Liang J, Du Y, Tan X, Xiang X, Wang W, et al. Reliability and reproducibility analysis of the Cobb angle and assessing sagittal plane by computer-assisted and manual measurement tools. BMC Musculoskelet Disord. 2014;15:33. doi: 10.1186/1471-2474-15-33. PubMed PMID: 24502397; PubMed Central PMCID: PMCPMC3922010.
  5. Ritter R, Nagasse Y, Ribeiro I, Yamazato C, Oliveira FMd, Kusabara R. Comparison of Cobb angle measurement in scoliosis by residents and spine experts. Coluna/Columna. 2016;15:13-6. doi: 10.1590/s1808-185120161501147274.
  6. Gstoettner M, Sekyra K, Walochnik N, Winter P, Wachter R, Bach CM. Inter- and intraobserver reliability assessment of the Cobb angle: manual versus digital measurement tools. Eur Spine J. 2007;16:1587-92. doi: 10.1007/s00586-007-0401-3. PubMed PMID: 17549526; PubMed Central PMCID: PMCPMC2078306.
  7. Al-Bashir AK, Al-Abed MA, Amari HK, Al-Rousan FM, Bashmaf OM, Abdulhay EW, et al. Computer-based Cobb angle measurement using deflection points in adolescence idiopathic scoliosis from radiographic images. Neural Computing and Applications. 2019;31:1547-61. doi: 10.1007/s00521-018-3614-y.
  8. Loder RT, Urquhart A, Steen H, Graziano G, Hensinger RN, Schlesinger A, et al. Variability in Cobb angle measurements in children with congenital scoliosis. J Bone Joint Surg Br. 1995;77:768-70. PubMed PMID: 7559707.
  9. Zardo EDA, Ziegler MS, Serdeira A, Severo C, Donazar M, Frast RV, et al. Applicability of the Cobb angle measurement in idiopathic scoliosis using scanned imaging. Coluna/Columna. 2017;16:22-4. doi: 10.1590/s1808-185120171601153058.
  10. Kundu R, Chakrabarti A, Lenka P, editors. Automated Cobb Angle Computation from Scoliosis Radiograph. New York: Springer. 2018. p. 140–55. doi:10.1007/978-981-13-1343-1_16.
  11. Okashi OA, Du H, Al-Assam H. Automatic spine curvature estimation from X-ray images of a mouse model. Comput Methods Programs Biomed. 2017;140:175-84. doi: 10.1016/j.cmpb.2016.12.010. PubMed PMID: 28254073.
  12. Stokes IA, Aronsson DD. Computer-assisted algorithms improve reliability of King classification and Cobb angle measurement of scoliosis. Spine (Phila Pa 1976). 2006;31:665-70. doi: 10.1097/01.brs.0000203708.49972.ab. PubMed PMID: 16540871.
  13. Chockalingam N, Dangerfield PH, Giakas G, Cochrane T, Dorgan JC. Computer-assisted Cobb measurement of scoliosis. Eur Spine J. 2002;11:353-7. doi: 10.1007/s00586-002-0386-x. PubMed PMID: 12193997; PubMed Central PMCID: PMCPMC3610477.
  14. Lee S, Lee J, Kim J, Kim K, Hwang C, Koo K-i. Precise Cobb Angle Measurement System Based on Spinal Images Merging Function. IRBM. 2018;39:343-52. doi:10.1016/j.irbm.2018.09.002.
  15. Greiner KA. Adolescent idiopathic scoliosis: radiologic decision-making. Am Fam Physician. 2002;65:1817-22. PubMed PMID: 12018804.
  16. Chen YL, Chen WJ, Chiou WK. An alternativemethod for measuring scoliosis curvature. Orthopedics. 2007;30:828-31. PubMed PMID: 17990407.
  17. He JW, Yan ZH, Liu J, Yu ZK, Wang XY, Bai GH, et al. Accuracy and repeatability of a new method for measuring scoliosis curvature. Spine (Phila Pa 1976). 2009;34:E323-9. doi: 10.1097/BRS.0b013e31819b2504. PubMed PMID: 19531987.