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Mobee211
03-24-2008, 06:24 PM
On my Xrays from 2006 the top vertebra of my cobb angle was c5. In these newest Xrays the top vertebra of the cobb angle is c7. This makes no sense to me. I know it matters in terms of the cobb angle. Anyone have any info/explanations? When I take the cobb angle measurement on these new xrays and use c5 as the top vertebrae (the way it was measured in 2006) I get 50 degrees as the cobb angle, NOT 40 degrees. I'm not an MD but shouldn't they be consistant with the vertebrae they use??

txmarinemom
03-24-2008, 06:32 PM
On my Xrays from 2006 the top vertebra of my cobb angle was c5. In these newest Xrays the top vertebra of the cobb angle is c7. This makes no sense to me. I know it matters in terms of the cobb angle. Anyone have any info/explanations? When I take the cobb angle measurement on these new xrays and use c5 as the top vertebrae (the way it was measured in 2006) I get 50 degrees as the cobb angle, NOT 40 degrees. I'm not an MD but shouldn't they be consistant with the vertebrae they use??


Who measured the two, Mobee, and what was their specialty?

Mobee211
03-24-2008, 06:38 PM
Who measured the two, Mobee, and what was their specialty?


I am not sure who measured the curve in 2006 but I know it was a staff radiologist at my doc office. And in 2008 it was another staff radiologist (I know his name but cannot put on internet). I called my doc office and left a message to inquire about this.

txmarinemom
03-24-2008, 06:52 PM
I am not sure who measured the curve in 2006 but I know it was a staff radiologist at my doc office. And in 2008 it was another staff radiologist (I know his name but cannot put on internet). I called my doc office and left a message to inquire about this.

Therein lies at least one issue. An scoli ortho should be measuring, not a radiologist ...

Mobee211
03-24-2008, 06:56 PM
thanks. i see the scoli specialist on 4/4. i was told at age 18 that my curve would never get any worse and i needed to not worry about it. yeesh. docs don't know everything!

txmarinemom
03-24-2008, 07:02 PM
thanks. i see the scoli specialist on 4/4. i was told at age 18 that my curve would never get any worse and i needed to not worry about it. yeesh. docs don't know everything!

A lot of us were told the same ... and that's what they thought. What they know now is leaps and bounds over 10 - even 5 - years ago.

On the other hand, mine hung ready to win the "Ms. Most Likely to Go Far in Life" award for 25 years ... and never moved. (my surgery was purely because it hurt more and more over the years).

It'll be interesting to see how one specialist reads the films. Good luck!

Pam

Mobee211
03-24-2008, 07:15 PM
Thanks. I will be interested to see what the scoli specialist says as well.

MATJESNIC
03-24-2008, 07:29 PM
Pam,

Why did you say a radiologist isn't the one who would read the x-rays the most accurate?

Pooka1
03-24-2008, 07:37 PM
Pam,

Why did you say a radiologist isn't the one who would read the x-rays the most accurate?

Radiologists are as qualified to measure the angle as are orthopedic surgeons.

Amazing.

sharon

Mobee211
03-24-2008, 07:52 PM
I think there is always some issue with which vertebrae to include at the top and bottom of the curve and scoliosis specialists are better at determining the correct vertebrae to use, as opposed to general radiologists. I think that is what Pam was getting at. In no way did she mean that radiologists cannot produce accurate measurements. I think she was just saying for the best results...always see a scoli specialist.

txmarinemom
03-24-2008, 09:49 PM
Radiologists are as qualified to measure the angle as are orthopedic surgeons.

Amazing.

sharon


Yes, dear.

txmarinemom
03-24-2008, 09:58 PM
Pam,

Why did you say a radiologist isn't the one who would read the x-rays the most accurate?

Melissa, radiologists - and garden variety orthos, for that matter (who practice scoli fusion between ACL repairs and rotator cuff tidy-ups) - don't have the experience of a scoli (or even spinal specialist).

amandap
03-25-2008, 09:06 AM
I agree with Pam on this one.

Although radiologists are qualified to measure curves it's difficult to get accurate/consistent readings because each radiologists/ortho/scoli specialits, etc. all measure differently so it's important for consisitency to have 1 person measure all the films.

From personal experiences Lorena's local pedi ortho measurements differ from the measurements @ Shriners Philly and for that matter Dr. D'Andrea, Dr. Betz, and Janets measurements (all @ Shriners Philly) differ, Dr. Betz always tend to be on the higher side.

That said ~ if two different radiologists measure the same curve chances are pretty hight the measurments will differ.

Just my two cents.

mariaf
03-25-2008, 09:18 AM
Now my two cents -

If it was my child, I would not want a radiolgist to measure the curve - I would want an orthopedic surgeon to measure it.

My reasons:

When David was first diagnosed, there was a significant difference between the radiologist's reading and the orthopedic surgeon's reading. Being a novice, I questioned them both about it - even the radiologist said his was an "estimate". The surgeon said that the radiologist's reading was basically just to see if there WAS a scoliosis, knowing that the ortho would follow up with a precise measurement.

After that first x-ray, nobody except an orthopedic doctor has ever read David's x-rays in the past EIGHT YEARS. I assume there is a reason for this.

Also, if you think about it, a radiologist takes xrays of EVERYTHING - ankles, arms, other body parts - he or she is not a SPINE SPECIALIST.

I don't think this is even a matter of opinion to tell you the truth. An ortho surgeon should be reading the xrays.

Of course, that's just MY view.

nate03
03-25-2008, 09:21 AM
I agree with what you are saying Amanda - and actually the drs in Boston told me that if Nathan was measured at 24 by local radiologist, it was likely that it was higher (this was based on their experiences with other patients coming in for the first time). They actually only measured 1 degree higher - on the same x-ray. But our appt. was a month later, so they redid the x-rays and found he had progressed to 38 degrees - clearly a progression, even with the typical +/- 5.
Also, I believe that the +/- 5 is a big factor in determining progression because there can be variables, such as the person reading x-ray, and I understand that curves can even vary slightly throughout the day.

-Cara

Mobee211
03-25-2008, 10:16 AM
Thanks everyone. I am sure I will find out the TRUE curvature when I see the orthopedic surgeon. I was just shocked that they measured using 2 different top and bottom vertebrae!!

amandap
03-25-2008, 11:58 AM
Two different radiologists doing the measurements ~ I wouldn't worry too much.

leahdragonfly
03-25-2008, 08:56 PM
The same vertebrae should be used for all measurements. I read recently in a juvenile scoliosis medical journal article (I think by Dr. Betz??-not sure now) that the leading cause for scoliosis to be referred to a pediatric scoliosis speciaty referral center is a false diagnosis of progression, where different vertebrae were used for the Cobb measurments.

Our 6 y/o daughter's initial films were measured by our local radiologist at 30 degrees, the pediatric scoliosis specialist in Portland remeasured it at 28 degrees, and Dr. Betz calculated 26 degrees (this was good news for us!).

Gayle

green m&m
03-26-2008, 12:32 AM
Yeah.. different radiologists using diff. vertebrae isn't good for comparing. My ortho re-measures previous years xray sometimes when measuring the new one.

Personally, I take radiologists readings(not x-rays... MRIs/CTs) with a huge grain of salt because I've had so many inadequate readings and outright misses. Granted, most rads won't see the findings that come up on my scans but the last one I had, I seriously had to question if the radiologist actually looked at my scan or not. :eek:

I think all the spine xrays I've had, if it was read by a radiologist, they just stated the direction and severity of the curve...(sever levoscoliosis blah blah)