Validity and Absolute Reliability of the Cobb Angle in Idiopathic Scoliosis with TraumaMeter Software.

The Cobb angle value is a critical parameter for evaluating adolescent idiopathic scoliosis (AIS) patients. This study aimed to evaluate a software's validity and absolute reliability to determine the Cobb angle in AIS digital X-rays, with two different degrees of experienced observers. Four experts and four novice evaluators measured 35 scoliotic curves with the software on three separate occasions, one month apart. The observers re-measured the same radiographic studies on three separate occasions three months later but on conventional X-ray films. The differences between the mean bias errors (MBE) within the experience groups were statistically significant between the experts (software) and novices (manual) (p < 0.001) and between the novices (software) and novices (manual) (p = 0.005). When measured with the software, the intra-group error in the expert group was MBE = 1.71 ± 0.61° and the intraclass correlation coefficient (ICC (2,1)) = 0.986, and in the novice group, MBE = 1.9 ± 0.67° and ICC (2,1) = 0.97. There was almost a perfect concordance among the two measurement methods, ICC (2,1) = 0.998 and minimum detectable change (MCD95) < 0.4°. Control of the intrinsic error sources enabled obtaining inter- and intra-observer MDC95 < 0.5° in the two experience groups and with the two measurement methods. The computer-aided software TraumaMeter increases the validity and reliability of Cobb angle measurements concerning manual measurement.

Validity and reliability of a computer-assisted system method to measure axial vertebral rotation.

Background: Axial vertebral rotation and Cobb's angle are essential parameters for analysing adolescent idiopathic scoliosis. This study's scope evaluates the validity and absolute reliability of application software based on a new mathematical equation to determine the axial vertebral rotation in digital X-rays according to Raimondi's method in evaluators with different degrees of experience. Methods: Twelve independent evaluators with different experience levels measured 33 scoliotic curves in 21 X-rays with the software on three separate occasions, separated one month. Using the same methodology, the observers re-measured the same radiographic studies three months later but on X-ray films and in a conventional way. Results: Both methods show good validity and reliability, and the intraclass correlation coefficients are almost perfect. According to our results, the software increases 1.7 times the validity and 1.9 times the absolute reliability of axial vertebral rotation on digital X-rays according to Raimondi's method, compared to the conventional manual measurement. Conclusions: The intra-group and inter-group agreement of the measurements with the software shows equal or minor variations than with the manual method, among the different measurement sessions and in the three experience groups. There is almost perfect agreement between the two measurement methods, so the equation and the software may be helpful to increase the accuracy in the axial vertebral rotation assessment.

Developing of a Mathematical Model to Perform Measurements of Axial Vertebral Rotation on Computer-Aided and Automated Diagnosis Systems, Using Raimondi's Method.

INTRODUCTION: Axial vertebral rotation (AVR) is a basic parameter in the study of idiopathic scoliosis and on physical two-dimensional images. Raimondi's tables are the most used method in the quantification of AVR. The development of computing technologies has enabled the creation of computer-aided or automated diagnosis systems (CADx) with which measurement on medical images can be carried out more quickly, simply, and with less intra and interobserver variabilities than manual methods. Although there are several publications dealing with the measurement of AVR in CADx systems, none of them provides information on the equation or algorithm used for the measurement applying Raimondi's method. Goal. The aim of this work is to perform a mathematical modelling of the data contained in Raimondi's tables that enable the Raimondi method to be used in digital medical images more precisely and in a more exact manner. METHODS: Data from Raimondi's tables were tabulated on a first step. After this, each column of Raimondi's tables containing values corresponding to vertebral body width (D) were adjusted to a curve determined by AVR = f (d). Third, representative values of each rotation divided by D were obtained through the equation of each column D. In a fourth step, a regression line was fitted to the data in each row, and from its equation, the mean value of the D/d distribution is calculated (value corresponding to the central column, D = 45). Finally, a curve was adjusted to the obtained data using the least squares method. Summary and Conclusion. Our mathematical equation allows the Raimondi method to be used in digital images of any format in a more accurate and simplified approach. This equation can be easily and freely implemented in any CADx system to quantify AVR, providing a more precise use of Raimondi's method, as well as being used in traditional manual measurement as it is performed with Raimondi tables.

Sitting Posture, Sagittal Spinal Curvatures and Back Pain in 8 to 12-Year-Old Children from the Region of Murcia (Spain): ISQUIOS Programme.

To explore sagittal spinal alignment and pelvic disposition of schoolchildren in a slump sitting position is needed in order to establish preventive educational postural programs. The purposes of this study were to describe sagittal spinal alignment and pelvic tilt (LSA) in a slump sitting position and to explore the association of sagittal spine and pelvic tilt with back pain (BP) among 8-12-year-old children. It was a cross-sectional study. Sagittal spinal curvatures, BP and pelvic tilt were assessed in 582 students from 14 elementary schools. It was found that 53.44% of children had slight thoracic hyperkyphosis and that 48.80% presented moderate lumbar hyperkyphosis and 38.66% presented slight lumbar hyperkyphosis. Those who did not suffer from BP in any part of the back had a higher lumbar kyphosis (24.64 ± 7.84) or a greater LSA (107.27 ± 5.38) than children who had some type of BP in the previous year or week (lumbar kyphosis: 23.08 ± 8.06; LSA: 105.52 ± 6.00), although with no clinically relevant differences. In fact, neither sufferers nor those who did not have BP presented normal mean values for lumbar kyphosis or LSA according to normality references. This study demonstrates the need to assess sagittal morphotype in childhood since schoolchildren remain incorrectly seated for many hours and it greatly affects their spinal curvatures.