Methodology of evaluation of morphology of the spine and the trunk in idiopathic scoliosis and other spinal deformities - 6th SOSORT consensus paper

Abstract

BackgroundComprehensive evaluation of the morphology of the spine and of the whole body is essential in order to correctly manage patients suffering from progressive idiopathic scoliosis. Although methodology of clinical and radiological examination is well described in manuals of orthopaedics, there is deficit of data which clinical and radiological parameters are considered in everyday practise. Recently, an increasing tendency to extend scoliosis examination beyond the measure of the Cobb angle can be observed, reflecting a more patient-oriented approach. Such evaluation often involves surface parameters, aesthetics, function and quality of life.Aim of the studyTo investigate current recommendations of experts on methodology of evaluation of the patient with spinal deformity, essentially idiopathic scoliosis.MethodsStructured Delphi procedure for collecting and processing knowledge from a group of experts with a series of questionnaires and controlled opinion feedback was performed. Experience and opinions of the professionals - physicians and physiotherapists managing scoliosis patients - were studied. According to Delphi method a Meeting Questionnaire (MQ) has been developed, resulting from a preliminary Pre-Meeting Questionnaire (PMQ) which had been previously discussed and approved on line. The MQ was circulated among the SOSORT experts during Consensus Session on "Measurements" which took place at the Annual Meeting of the Society, totally 23 panellists being engaged. Clinical, radiological and surface topography parameters were checked for agreement.Results90% agreement or more was reached in 35 items and superior than 75% agreement was reached in further 25 items. An evaluation form was proposed to be used by clinicians and researchers.ConclusionThe consensus was reached on evaluation of the morphology of the patient with idiopathic scoliosis, comprising clinical, radiological and, to less extend, surface topography assessment. Considering the variety of parameters indicated by the panellists, the Cobb angle, yet the gold standard, can be seen neither as the unique nor the only decisive parameter in the management of patients with idiopathic scoliosis.

Consenso de escoliosis idiopática del adolescente

“…II., alteraciones de la cadera o distorsión pélvica. 12 Con el paciente de perfil, se debe observar lo siguiente:…”

Emerging Technology and Analytical Techniques for the Clinical Assessment of Scoliosis

“…In recognition that a comprehensive description of the complex deformity and disorientation of the spine and adjacent skeletal structures extends beyond the scope of these standard anatomical terms, collective work has assembled detailed terminology to describe spinal deformity [20,36,37]. These work groups have provided terms of reference that describes deformity, alignment and shape of the spine, and the alignment (position/orientation) of individual vertebra and adjacent skeletal structures such as the pelvis, thorax and scapula.…”

“…The terms and measures that have been adopted to describe the position and orientation of the pelvis are quite extensive, and specific to the sacrum, iliac bones and pelvis [34,36,38,[42][43][44][45]. The anatomical landmarks that provide the point of reference to describe the pelvis include: Anterior-Superior Iliac Spines (ASIS), Posterior-Superior Iliac Spines (PSIS), Superior Lateral Border of the Iliac Crests, and the Sacral Plateau [34,36,38,[42][43][44][45].…”

“…The anatomical landmarks that provide the point of reference to describe the pelvis include: Anterior-Superior Iliac Spines (ASIS), Posterior-Superior Iliac Spines (PSIS), Superior Lateral Border of the Iliac Crests, and the Sacral Plateau [34,36,38,[42][43][44][45]. These landmarks have served to measure pelvic position and orientation radiologically [38] and with optoelectronic and digitization techniques [34,[42][43][44][45].…”

“…With the exception of the Adam's forward bending test [12,13], the upright static standing posture has served as the frame of reference for clinical characterization of spinal deformity. However, there are emerging criticisms that question the relevance of one measure of spinal deformity such as the Cobb angle as one of the primary indicators of surgical outcomes [36]. In part, this criticism is founded on the recognition that the spatial deformity of the spine extends beyond the characterization provided by one summary measure, inconsistencies in surgical decision making [59] and is paralleled by evidence that it does not correlate with perceptions of appearance by parents and patients [60].…”