Scoliosisis a lateral curvature of the spine. Adolescent idiopathic scoliosis is the most common type of scoliosis which typically has an onset after 10 years of age. | Scoliosis and the Cobb Angle: Jorge Muniz, PA-C
Aetiology
Idiopathic (M/C, 80%)
Diagnosis
The degree of curvature of the spine is determined by the Cobb angle. A curve with a Cobb angle ≥ 10 degrees defines scoliosis. To determine the Cobb angle, begin by identifying the vertebrae at the upper and lower limits of the curve. Lines are then drawn extending along the outer vertebral borders. From these lines two more perpendicular lines are constructed. The Cobb angle is formed by the intersection of these lines.
Cobb angle measurement in scoliosis | Copyright (c) 2005 Skoliose-Info-Forum.de, Skoliose-Info-Forum.de GNU Free Documentation License 1.2
Management
Moderate curves (20 to 40 degrees) are treated conservatively with physical therapy and bracing. Severe curves greater than 40 degrees may require surgery.
Scoliosis patient in Chêneau brace correcting from 56° to 27° Cobb (primary correction of 52%). | Weiss HR. Scoliosis 2007, 2:19. PMID: 18163917. doi:10.1186/1748-7161-2-19., CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=9768629
Preoperative (left) and postoperative (right) X-ray of a person with thoracic dextroscoliosis and lumbar levoscoliosis: The X-ray is usually projected such that the right side of the subject is on the right side of the image; i.e., the subject is viewed from the rear (see left image; the right image is seen from the front). This projection is typically used by spine surgeons, as it is how surgeons see their patients when they are on the operating table (in the prone position). This is the opposite of conventional chest X-ray, where the image is projected as if looking at the patient from the front. The surgery was a fusion with instrumentation.
This is an posterior-to-anterior X-ray of a case of adolescent idiopathic scoliosis – specifically, my spine. There is a thoracic curve of 30° and a lumbar curve of 53° (Cobb angle – see scoliosis). This was taken at the Royal National Orthopaedic Hospital. The largest curve (53°) is of a magnitude typically near the lower surgery boundary, although many factors decide whether surgery is necessary on a scoliosis case. | Silverjonny – http://en.wikipedia.org/wiki/Image:Wiki_pre-op.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1493715
Summary This is an anterior-posterior X-ray of a case of adolescent idiopathic scoliosis post-fusion – specifically, my spine. There was originally a thoracic curve of 30° and a lumbar curve of 53° (Cobb angle – see scoliosis) and these curves have been reduced to less than 15° each. This was taken at the Royal National Orthopaedic Hospital. The largest curve (53°) is of a magnitude typically near the lower surgery boundary, although many factors decide whether surgery is necessary on a scoliosis case. This x-ray was taken almost a year after this x-ray was taken of the same spine pre-op: The spine has been fused with Synergy spinal instrumentation [1] [2] (page 2) during an anterior and posterior fusion. Vertebrae T1-L3 have been fused using a combination of rods, screws and hooks, and bone graft. | Silverjonny – http://en.wikipedia.org/wiki/Image:Wiki_post-op.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1493727
