Cobb Angle Measurement

[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

[S4Sarah]

That happened to me, the Radiologist, the reviewing doctor, and my actual doctor had different results. They were like 5 degrees off. it does not sound like too much but it can make a difference in treatment. that five degrees made the difference between mild and moderate. My Lumbar curve is now moderate and Mid-Throatic curve is mild. I think they are a little off though, they feel worse than what my real doctor who corrected them said. They also feel worse at the end of the day I have heard about curves worsening a couple degrees throughout the day then going back. It has to do with the flexibility of the spine or something like that.

Anyway I have my X-rays on a CD and would like to measure them myself. Any good websites or tips? I tried doing it on the computer but I don't think I did it right because every time it came out to really outragous numbers like 40 degrees.

[txmarinemom]

That happened to me, the Radiologist, the reviewing doctor, and my actual doctor had different results. They were like 5 degrees off. it does not sound like too much but it can make a difference in treatment. that five degrees made the difference between mild and moderate. My Lumbar curve is now moderate and Mid-Throatic curve is mild. I think they are a little off though, they feel worse than what my real doctor who corrected them said. They also feel worse at the end of the day I have heard about curves worsening a couple degrees throughout the day then going back. It has to do with the flexibility of the spine or something like that.

Anyway I have my X-rays on a CD and would like to measure them myself. Any good websites or tips? I tried doing it on the computer but I don't think I did it right because every time it came out to really outragous numbers like 40 degrees.

You know the margin of error is ±5°, right? It can be as much as ±10° if shot by a different x-ray tech and read by a different doctor - especially when switching between scoli specialists, MD's, DO's and DC's ...

And, hon .. ±40° isn't all that "outrageous". Especially if you measured them yourself.

[FixScoliosis]

Hi S4Sarah

Measuring the Cobb Angle is quite easy.
Here is a good description on how to do it.
http://www.e-radiography.net/radpath/c/cobbs-angle.htm

good luck.

[titaniumed]

Due to the parameters involved in measuring cobb angles, one of the things that was nice with me was the fact that I had 25 years of x-rays. I can actually wallpaper my bedroom with all of them.

You can see the fluctuation of angles through the years, with minimal movement from age 25 to 40. In other words, I could average all the angles out, and come up with a number. You can also see where I had ski crashes and vertebrae would move out of position and eventually return to their mean scoliotic position.

My problems started at age 41. That's where I started progressing.

I've been exposed to a few REMs through the years...... No cancer so far, knock on wood. Must be all the veggies and the hydrogen peroxide. LOL
Ed

[concerned dad]

There is a new method I saw proposed by some doctors in Asia. Their paper discussed all the problems and challenges with measuring the Cobb angle. Their method, they claim, significantly reduces the errors.

Attached is a Figure from their report comparing their method with the Cobb method. I may give it a try and compare my daughters pre brace and inbrace x-rays from Montreal.

I do see one problem with their method and am wondering if anyone else picks it up.

And, S4Sarah, I am guessing you have more than one curve (S?). I could be wrong but I think multiple curves probably add some challenges to the reading, at least so far as picking the right vertebrae to use for the end points. My daughters curve is much like the one inthe attached figure and is pretty simple to pick the right end points (although, <cough> apparently some people in Montreal may disagree)

[SpiderPug]

Concerned Dad,

I see this problem with the new method: The method appears to assume that the C7 vertebrae is centered over the pubic symphasis. However, this is not the case in many with scoliosis, so the upright line would be tilted at an angle, especially in those with a trunk shift. This would seem to make the measurements inaccurate.

Is this the problem you see, or did you see something else?

[FixScoliosis]

Good that you picked it up CS.
SpiderPug, you are correct it that there should be mentioned how much C7 is off the vertical alignment with reference to pubic symphisis.

I wrote a blog post about that paper a while back 'Cobb Angle compared with ALDT to measure Scoliosis' and I would suggest to combine both methods.

just my 2 cents..

[concerned dad]

Concerned Dad,

I see this problem with the new method: The method appears to assume that the C7 vertebrae is centered over the pubic symphasis. However, this is not the case in many with scoliosis, so the upright line would be tilted at an angle, especially in those with a trunk shift. This would seem to make the measurements inaccurate.

Is this the problem you see, or did you see something else?

No, that's not what I picked up but a point well taken.

I was thinking along the lines of the fact you are measuring a distance rather than an angle.

The distance between the film and the subject doesnt matter if you are measuring an angle. It does matter (I think) if you are measuring a distance.