Cobb Angle Measurement

[rtremb]

I am wondering if anyone has had any problem finding out the actual Cobb angle of their curves?

We have a huge discrepancy between the doctor's measurements and the official radiology report from the Children's Hospital of Eastern Ontario (CHEO).

The doctor told us, at an appointment, that my daughter's angles were T56 and L50. One week later he changed his reading to T52 and L49. The doctor recommended surgery in six months.

The chiropractor measured the angles in front of us and got T45, L45.

Today we now have the official radiology report from CHEO which states her angles are T42 and L38.

The difference between these readings is huge. Our paediatrician has told us in the past to trust the radiology report (there has always been differences before between the doctor's reading and radiology).

Has anyone else come across these discrepancies in the reading of Cobb Angles?

[scoliboymom]

I actually learned how to measure the cobb angle and always got a copy of the x-rays, more because I couldn't wait to find out what was happening with my sons spine. My results were within 5 degrees of what the doctors found. One time the radiologist made a mistake and found the curve hadn't changed at all when in fact it had increased significantly. I e-mailed the doctor and asked if he could remeasure and he did and he agreed there had been a mistake.
I wouldn't hestitate to ask the surgeon to remeasure the x-rays. The results you are getting are quite different and do make the difference between possibly needing surgery or not.
Is it possible to get another doctors opinion?
My son had his surgery this year at Sick Kids in Toronto and for the most part it was a positive experience. Their ortho team is nothing but excellent. Maybe you could get a second opinion from them?
By the way has your daughter finished growing and have her curves been steadily increasing?

Ramona

[rtremb]

Ramona:

Thanks for your post.

These new Cobb angles from radiology are their second read on Esme's x-rays (the surgeon asked for a second read from them since the first read seemed so off). The surgeon has also done two readings as well!! We are a bit confused to say the least but we will keep trying to get to the bottom of it. We were very devastated when the doctor said Esme needed surgery so we are hopeful the radiology department has the right readings (wishful thinking!!). I will ask for a copy of Esme's x-rays from now on.....

We are going to see Dr. Rivard in Montreal as soon as we can get an appointment - he has agreed to see our daughter Esme. Hopefully they will give us a less confusing read on her angles. We are hoping for a Spinecor brace.

Our daughter's scoliosis is s-shaped and has been progressing steadily over the past 2+ years. She is not finished growing. The surgeon estimated she is a 0-1 Risser although he couldn't be sure since they didn't have the appropriate x-ray to show that clearly. She is premenarchial.

Our son has an s-shaped scoliosis too and it looked like he was headed for surgery however we were fortunate - his curves seem to have stopped progressing and have even reduced a bit. He did not wear a brace. He is 17 this weekend so we are hoping his curves won't progress now.

Glad to hear all went well with your son's surgery. It must be so hard to go through - I think it must really help if you have doctors you feel good about.

[rtremb]

At this point we are having to think the radiologist made an error when he read Esme's x-rays since three doctors have now measured her curves at or just over 50 degrees. The radiologist who read the x-rays is away until later in the month so we aren't able to get an explanation from him yet.

[rtremb]

Does anyone know an internet link that describes how to measure thoracolumbar curves?

[Susie*Bee]

This site might help you out... scroll down a little and it shows how to figure Cobb angles.

http://www.pediatriceducation.org/2006/12/11

The main problem with different people determining the angle is that they might choose different beginning and ending vertebrae, which would throw the whole thing off. Sometimes looking at the x-ray, it doesn't look like a definite "this is where to start" spot... and even just drawing the lines can lead to some error, so that is why they say give or take 5º.

You can probably pull up other links just by googling "how to measure cobb angles"--

[WNCmom]

This site might help you out... scroll down a little and it shows how to figure Cobb angles.

http://www.pediatriceducation.org/2006/12/11

The main problem with different people determining the angle is that they might choose different beginning and ending vertebrae, which would throw the whole thing off. Sometimes looking at the x-ray, it doesn't look like a definite "this is where to start" spot... and even just drawing the lines can lead to some error, so that is why they say give or take 5º.

You can probably pull up other links just by googling "how to measure cobb angles"--


Ruth--

This is what happened to us. Our chiro actually got a bigger angle than the hospital did, and he told us he was measuring a different vertebra that had the greater angle. Since then we've been going with his measurements so we can compare apples to apples.

[txmarinemom]

And, actually, if the x-rays are read by different doctors, the margin of error can be ±10°.

Regards,
Pam

[Singer]

I had a radiologist and 2 different scoliosis specialists read my x-rays and their measurements were 55, 60, and 70 degrees, respectively. I noticed that my surgeon measured my main curve on the outside of the curvature, whereas the other specialists measured it on the inside.

[txmarinemom]

I had a radiologist and 2 different scoliosis specialists read my x-rays and their measurements were 55, 60, and 70 degrees, respectively. I noticed that my surgeon measured my main curve on the outside of the curvature, whereas the other specialists measured it on the inside.

Singer, by "on the outside", I assume you mean from the top (or bottom) of the vertebra? (mine was T5-L1 ... it was measured above T5, and below L1).

That's actually the only way I've ever had anyone measure mine (in almost 30 years), and everything I've ever read on Cobb measurement describes it that way. Measuring below the top involved vertebra or above the bottom involved vertebra (preaching to the choir here, I know!) could make a HUGE difference.

It could also be VERY dangerous - and an invitation for decompensation. Eek!

Even the surgical plan with one doctor can vary. Hanson and I had agreed on T5-L1, but the morning of surgery (after more examination of the films) he said he'd really feel better if we took T4 as well because he felt it *could* possibly be involved in the structural curve.

T4 for me was kind of a no-brainer since I'd already agreed to T5 (and it's not really a "bending area", per se).

I honestly feel he did the right thing going higher: The cervical pain I had in the compensatory curve (whiplashed area also ... 3mm protrusions at C5-C6/C6-C7) is GONE. Maybe it has nothing to do with fusing higher, maybe so.

Now, if he'd told me he wanted L2, I've had probably put things on hold.

I know plenty of people get on with life with a lumbar fusion (and remember my curve wasn't progressing, nor did the MRI show degeneration), but I think I'd probably have decided to tough it out a few more years (yes, for softball).

At some point I'd have let him do it if he thought it was necessary, I just wasn't ready YET for that. Luckily, I didn't have to make that choice.

Regards,
Pam

[rtremb]

Thank you all for your comments. We have had this happen in the past too where the x-ray readings differ radically when done by a surgeon, a chiro or the radiology department.

While I can see that Esme's curves have progressed I wanted to check the measurements myself but am not quite sure how to figure out which vertebrae is which so I can compare the measurement to previous ones (i.e., use the same vertebrae to measure).

Also since Esme's has two curves (thoracolumbar) not sure where the apex would be.

Ruth

[txmarinemom]

Each structural curve should have it's own apex, Ruth.

Regards,
Pam

[rtremb]

I have attached Esme's March 13, 2008 x-ray. Scary looking!! If anyone would like to measure it and tell me what you think her curve measurements are I'd really appreciate it.
Ruth

[txmarinemom]

I have attached Esme's March 13, 2008 x-ray. Scary looking!! If anyone would like to measure it and tell me what you think her curve measurements are I'd really appreciate it.
Ruth

Ruth, I realize you're looking for answers, but unless we have a surgeon on this board, I REALLY think it's a bad plan to have a bunch of laypeople (and I don't care *how* many times they've played around with their *own* x-rays) measure Esme's.

You've seen written where even with professionals the margin of error can range from ±5° to ±10°. You need to wait and get YOUR surgeon's answer.

What you're asking is definitely setting yourself up for more confusion - and potential freak out ... just because someone knows how to do it *IN THEORY* doesn't mean they can do it accurately.

Regards,
Pam

[Aussiemum]

In all honesty Ruth - what does it matter??

If she had one doctor telling you 30 and another one 42 THEN I could understand the urgency in deciding the correct measurement. As you know the consensus is once over 40 degrees bracing is no longer contemplated.

So while I understand you wanting to know the EXACT measurement (as I would) I don't think it really comes into play in making a decision for the next step. Her x-ray looks quite severe to me.

It seems everyone has their own style of measuring the cobb angle (I experienced something similar to yourself between doctors) but so long as you get the same person each time to measure the progression then the rate should be accurate. I just stuck with my Surgeon and his expertise, I never relied on what the Radiologist wrote. I just figured my Scoli surgeon was looking and measuring these types of things all the time and he was the most qualified to do the job.

It's all very frustrating, isn't it! Hope you can get it all sorted out one way or another.

Cheers
Del

[rtremb]

A concern I have with getting an accurate read of the x-ray is that if Dr. Rivard's mesasurement is correct Esme's curves are advancing at an alarming rate. 14 degrees in just over three months seems fast to me anyway. If she is advancing that quickly then she needs to see the doctor at CHEO sooner than the April 28th appointment they have given us.

I don't mind if people want to have a try measuring her curves. I have been doing it with the software which came with the x-ray files and have been unable to come up with the same cobb angles as Dr. Rivard - my measurements are coming out lower but still in the 50's. When I measure a hard copy with a ruler and a protractor I am getting lower measurements too.

I am not going to base any decisions for action based on the measurements anyone comes up with - I am just curious what other people might get if they try to measure her curves.

Ruth

[DaveWolpert]

I wanted to add my two cents on a few things here:

First, in general, I would not rely on a chiropractor to measure a scoliotic curve. They rarely have any formal training on how to do this, and I’ve seen some horribly inaccurate measurements from some. So, Ruth, of the three measurements you received, I’d only consider the surgeon’s and the radiologist’s as meaningful.

Second, as others have noted, keep in mind that there’s a margin of error of 5-10 degrees in Cobb angle measurements, not just due to choices or errors in measurements but also because a spine’s curvature may vary by a few degrees over the course of a day. I'd focus on the largest curve measurement (thoracic), not the smaller one (lumbar).

Third, I agree with Aussiemum’s general point that knowing the exact measurement isn’t critical. Whether Esme's thoracic curve is 42 or 56 degrees, it’s clearly close to or in the lower-end of the range at which surgery is indicated (most surgeons have a 45 or 50 degree minimum). And, because Esme is only 13 and surely has some more growing to do, it’s statistically almost a certainty that her curve will progress further – how much so is impossible to predict, but even if it progresses 10 more degrees by the time she’s skeletally mature, surgery will almost certainly be recommended by your surgeon eventually.

Also, the rate of curve progression isn’t linear. Even if Esme’s curves have in fact progressed 14 degrees in three months, that doesn’t mean they’ll progress by the same amount in the next three months.

I hope this helps!

Dave

[txmarinemom]

Nice to officially "meet" you, Dave!

BTW, *fantastic* book. My surgeon recommends ALL his patients read it before deciding on surgery, and in turn, I recommend it highly every chance I get.

Best regards,
Pam

[rtremb]

Thanks Dave.

I agree with all you say. I am still finding the idea of surgery hard to handle though and we were pursuing non-surgical treatments for Esme which we have to decide whether to continue with or not or whether to go straight to surgery.

We only have one doctor's reading of Esme's x-rays so far.

The measurement matters to me in that the structural integration treatments Esme has been having (10 so far) have made her back look cosmetically really really great but the x-rays are showing a different story. In fact it seems to me that the cobb angles don't fit with the photo of her back.

I have attached a photo of her back which you can look at - I want to leave it on here only for a couple of days.

Ruth

[Aussiemum]

Hi Ruth,

I can see where your coming from because Esme's back does cosmetically look quite okay. Elysia didn't have the Lumbar curve that Esme had and she had much more of a tilt on her than Esme has. I think I'm correct in saying that for Esme the reason is that she has an S curve - Thoracic 62 and Lumbar 63 - wasn't that one of the measurements they gave you? So that means that her trunk is bending one way and then again the other.

After she has surgery you will definately see some major height changes for her. Scoli x-rays look very scary - you can't always see the real internal drama that's going on from the outside. Have a read of our blog, Elysia's before and after x-rays are on there. I'll try and put up a picture later of her back before surgery on there as well - there's one of her hump if you scroll down through the older posts.

cheers
Del

[Aussiemum]

There you go Ruth - I've put up the before and after shot on the blog - wow - even I'm impressed looking at the difference between the two. Elysia is quite thin too so not much there to hide anything - I could see her curve in her spine just with the naked eye! But she's all skin and bones.
So, if she had a large Lumbar curve she would have balanced out as well.
Hope this helps somewhat.
Del

[rtremb]

Del:
Thanks for sharing the photos. Elysia's back looks really good now.
Ruth