Measurements

[DrStitzel]

I do find that shocking! I think that it's good that you will be publishing this; if that is indeed the situation in Singapore then it is a problem that needs highlighting! I've just spoken about this with a colleague and they are also of the opinion that no scoliosis surgeon of any calibre would operate based purely on the Cobb measurement. Which journals will you be publishing in?

I think a misunderstanding has turned this conversation in an incorrect direction. The article Dr. Morningstar and I are publishing is a commentary on the obsoleteness of cobb's angle and highlights the need to convert the "gold standard" for scoliosis evaluation over into a system that includes both the lateral bending and rotational components of scoliosis.

However, a world-wide consensus on scoliosis surgery evaluation and determination is long over-due.

[Goldfinch]

Hi Clayton! Nice to see you again

I'm not surprised if US surgeons don't sit down and explain to the patients every factor they have taken into consideration before deciding to operate. They don't here in the UK either - it would take too long, and most patients don't want to be overwhelmed with technical details at a time when they are digesting the news that surgery is recommended. However, a lot of work goes on in the background to assess the patient's individual case, and no surgeon will just glance at an x-ray, measure the Cobb at 40 degrees and order surgery. We have weekly meetings to discuss surgical cases, which last several hours and take into account many different factors - the decision to operate is never taken lightly. I do know that this is standard procedure in most of the larger US hospitals and other centres around the world.

If patients ask questions, they get answered. I often get patients or their parents contacting me for more detailed information following the appointment, and part of my job involves retrieving this info for them, making sure it is delivered to them and that they understand it.

Hope this is of some interest to you!

[Goldfinch]

Oh, I see what you mean! Well, as far as I know the "gold standard" for evaluation already includes the lateral bending and rotational aspects of scoliosis, at least in the larger centres in the UK. If this isn't the case in other countries then you are doing well to highlight it.

I can't comment on whether the Cobb Angle should be declared as an obsolete measurement, as it seems to work well alongside all of the other factors that are taken into consideration. I'll be very interested to read the study - where is it being published? I'll mention it to the surgeons at my centre, they may well be interested too.

[DrJosh]

Sorry to jump in;


I put together an article on measuring Cobb Angle for CLEAR Institute's newsletter a while back, and it wasn't very well-received (no one took the time to submit their results), but it still exists, and if it can be helpful, I've made it publically available for download here:

http://drop.io/cobbangle

It's just a simple pdf file with instructions on how to measure Cobb Angle, along with a few sample x-rays to try it on. It also illustrates the most common errors involved in measuring Cobb's angle.

Rotation is a bit trickier, but the best article I've read on the topic is available here as full-text:

http://www.scoliosisjournal.com/content/3/1/16

Again, please pardon me for jumping in! I hope this info is helpful.


Best Regards,
Dr. Josh

[DrStitzel]

Which journals will you be publishing in?

Hi Goldfinch,

Our commentary on Cobb's angle will be published in Journal of Pediatric, Maternal, and Family Health. I don't know when exactly, but I think it will be fairly soon.

[Goldfinch]

Thanks Clayton! As a publication for Chiropractors our hospital medical library does not subscribe to this journal, but I found the abstract online. It looks as though you are explaining to other chiropractors why they shouldn't simply rely on the Cobb Angle measurement to assess scoliosis, and that is of course quite right! I applaud your efforts in this.

As chiropractors I think there is a particular need for your professional to show that it is aware of standard medical practice for scoliosis, in order for the medical profession to take your studies and findings seriously so that you can work together for the common good. Any chiropractors who simply rely on the Cobb Angle measurement in this way will be doing your profession a disservice, because scoliosis surgeons would find the idea of someone doing this to be absolutely ludicrous and would probably write them off as ignorant or incompetent. That is the very last thing that we need if we are trying to gain credibility for nonsurgical methods!

Excellent work, I'd be interested to read the whole article if you are able to make it available to a non-subscriber

[DrStitzel]

Here is a PDF of the cobb angle commentary Dr. Morningstar and I collaborated on.........enjoy?

[mamamax]

Sorry to jump in;


I put together an article on measuring Cobb Angle for CLEAR Institute's newsletter a while back, and it wasn't very well-received (no one took the time to submit their results), but it still exists, and if it can be helpful, I've made it publically available for download here:

http://drop.io/cobbangle

It's just a simple pdf file with instructions on how to measure Cobb Angle, along with a few sample x-rays to try it on. It also illustrates the most common errors involved in measuring Cobb's angle.

Rotation is a bit trickier, but the best article I've read on the topic is available here as full-text:

http://www.scoliosisjournal.com/content/3/1/16

Again, please pardon me for jumping in! I hope this info is helpful.


Best Regards,
Dr. Josh

Thank you Josh! Overall, that looks like a good teaching tool :-)

[Goldfinch]

It's a good article Clayton! You make a good case to other members of your profession that they shouldn't solely rely on Cobb Angle measurement. I hope they take note. I don't agree that the measurement is obsolete, purely because it works well in its usual context alongside the other methods of assessing the extent of a scoliotic deformity. However, so long as a range of metrics are taken in order to give a full description of the spine, then I can't see the harm in anyone preferring to use other methods instead

[DrStitzel]

I think we can find common ground on the subject.......radiographic lateral flexion (cobb angle) may provide some reasonably useful info about the curvature in coordination with other data, but still provides very little usefulness in regards to how to treat the patient. Radiographic lateral flexion (cobb angle) doesn't really correlate much of anything in terms of organic health measures and SOSORT even goes as far as ranking it 12th out of 21 outcome assessment factors in scoliosis treatment.

The spine has 24 moveable vertebrae and each one has individual movement ability, but they don't move individually (no one can "wiggle" one vertebra for example). The vertebra move in a series of "groups" (determined by common muscle attachments) to create functional units. The functional units create mechanical advantage for spinal function via a lever arm system. The cobb angle is really just the summation of all the function units that are combining to form the curvature (for example, if units 2,3,&4 all twisted to the right it would produce a right thoracic cobb angle). So the cobb angle may tell you the total magnitude of the combination of the functional units, but doesn't tell you anything about the curve's composition....and knowing the composition of the curve provides a ton of useful treatment information about the most effective treatment method selection for that particular patient's curve composition.

We're really just further breaking the cobb angle down into the even smaller individual curves (created at the intersection of each functional unit) and creating treatment plans/methods for treating each of the smaller curves, that when added together, equate to the cobb angle. It is the exact opposite concept of evaluating scoliosis via curve pattern......instead of trying to swallow the entire elephant; we're breaking it down in bite size pieces (metaphorically)

Do you see what I mean when I say cobb angle is obsolete? Perhaps it would be more accurate to say that cobb’s angle is "incomplete", because we have the knowledge to continue refining the measurement system down into even finer and more accurate levels that provide info about the curves composition and not just its magnitude.....It really opens up an whole new realm of possibilities and concepts when you can gain a fresh perspective on the condition.