Thomas H. Colburn, Donald E. Katz, Keith Smith
Scoliosis orthoses are designed for children with Adolescent Idiopathic Scoliosis
through a combination of clinical and radiographic evaluation. The standing PA x-ray is
an essential tool for designing or blueprinting the scoliosis orthosis. Most frequently
poeople refer to the Cobb angle when referring to a scoliosis x-ray interpretaion. The
most frequently referenced barometer of curve correction is the Cobb angle reduction in
an orthosis. The Cobb angle is helpful for quantifying the magnitude of a scoliosis curve,
but is limited in scope to a two dimensional angular relationship between two angulated
vertebrae and does not relay the complex nature of a three dimensional individual curve.
One example of the limitations of the Cobb angle are seen in patients which may have a
significantly decompensated curve which measures as a small Cobb angle primarily
because the inferior vertebral endpoint is angulated, but the superior vertebral endpoint is
more horizontal and does not angulate back towards midline. In the situation of two
patients with identical inferior endpoint angulations with one patient decompensated to
one side and one patient fully compensated and balanced, the decompensated scoliosis
patient would have a smaller Cobb angle than the more balanced fully compensated
scoliosis patient. Cobb angle reference alone would not identify this.
The orientation of the scoliosis curve in relation to the central sacral line on
radiograph, or the overall clinical balance of the trunk is a relationship which should be
closely evaluated. The presentation shall closely look at how clinical trunk balance and
the relationship of the spine to the central sacral line is used in blueprinting and designing
a scoliosis orthosis, as well as the significance of how it is used in evaluating an orthosis
on the patient.
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