Radiographic measurement error of the scoliotic curve angle depending on positioning of the patient and the side of scoliotic curve

Background The Cobb angle measurement is well established for the measurement of coronal deformity aspect of scoliotic curves. The effect of positional differences in relation to the apex side of the scoliosis is not yet fully quantified. While theoretically plausible that positioning error with rotation toward the apex of the scoliosis would decrease the Cobb angle, the relations are not investigated yet and were object of this study. Materials and methods Multiple measurements of the Cobb angle were performed, while turning a spine-pelvic cadaveric specimen with a right-sided thoracic scoliosis of 47° (in neutral position) from 45° to −45° in steps of 5° using biplanar radiography. Statistical methods were applied to find the critical position, in which measurement errors potentially become clinically relevant (Cobb angle deviation >5°). Results Turning the specimen to the right (toward the apex of the scoliosis) produced during the first −15° of rotation, a Cobb angle ranging from 47° to 45°. At −20°, the Cobb angle was 42°, at −25° rotation 37° and at −30° rotation 36°. Above −30° rotation, the measured Cobb angle decreased to 36° (77 % of the original Cobb angle). No relevant differences were found by rotating the specimen to the left (away from the apex) (47° at neutral rotation and 44° at maximal error rotation of +45°). Conclusion The influence of rotational misplacement of the patient at the time of image acquisition on Cobb angle measurements is negligible for a rotational misplacement of ±20° of rotation for a idiopathic right-sided thoracic scoliosis of 47°. Over 20° of rotational misplacement of the patient toward the apex of the scoliosis falsely decreases the Cobb angle.