![]() The secondary objective was to evaluate the accuracy, reproducibility and reliability of this method. The 3D scoliosis angle was evaluated based on two standard X-rays: PA and lateral. The primary objective of the study was to propose a novel method for calculating the 3D angle that exists between the upper endplate of the upper-end vertebra and the lower endplate of the lower-end vertebra (hereafter called the 3D scoliosis angle). The increasing interest in the 3D parameters of scoliosis and the wide use of X-rays for scoliosis evaluation have caught our attention in terms of the evaluation of the 3D character and magnitude of scoliosis. Presumably, this is because systems for the 3D analysis of scoliosis, such as the EOSTM imaging system, are not widely accessible. Nevertheless, two-dimensional X-ray evaluation has prevailed in the evaluation and follow-up of patients with adolescent idiopathic scoliosis (AIS). The evaluation of three-dimensional deformities has the following feasible parameters: the axial rotation of the vertebra, the orientation of the plane of maximum curvature (PMC), the angle of scoliosis observed in the PMC, and the top view parameters. Despite a few parameters, the evaluation of scoliosis refers mainly to two two-dimensional planes: coronal and sagittal. These findings emphasized the importance of 3D parameters. Two cases of scoliosis with similar two-dimensional morphologies may have different three-dimensional morphologies. Studies have indicated that 3D scoliosis patterns can be predictive of deformity progression. The 3D character of scoliosis renders the three-dimensional diagnostic evaluation preferable. The Cobb angle measured on the PA X-rays does not demonstrate the angle between the end vertebrae observed in three-dimensional (3D) space. The magnitude of scoliosis is typically measured with the Cobb angle on posteroanterior (PA) X-rays of the spine. Scoliosis is a three-dimensional deformity of the spine. Considering the 3D nature of AIS, the 3D parameters of the spine may help to apply a more effective treatment and estimate a more precise prognosis for patient with scoliosis. The proposed method facilitates 3D-scoliosis assessment without the use of sophisticated devices. Conclusionsīased on two standard radiographs, PA and lateral, it is possible to calculate the 3D scoliosis angle. The reproducibility and reliability of 3D angle measurements were high. There was, however, a significant difference between the 3D-scoliosis angle and the Cobb angle measurements performed based on the X-rays. There was no significant difference between the 3D-angle measurements obtained with DRRs versus CT, p > 0.05. The results were tested with the Student’s t-test, and the agreement of measurements was tested with the intraclass correlation coefficient. ![]() In the case of the DRR, the 3D angle was calculated using the four-angle method: the angles formed by the endplates of the curve with the transverse plane. ![]() In the case of CT, the 3D angle was calculated based on the coordinates of three points situated on the upper endplate and those of three points situated on the lower endplate of the scoliosis curve. The 3D-angles of thirty scoliosis curves were measured with either computed tomography (CT) or digitally reconstructed radiographs (DRRs): PA and lateral. ![]() The proposed method consists of the measurements of the angles between the upper endplate of the upper-end vertebra and the lower endplate of the lower-end vertebra (3D scoliosis angle). We propose a novel method for evaluating the three-dimensional (3D) pattern of scoliosis based on two X-rays (PA and lateral). Three-dimensional idiopathic scoliosis cannot be accurately assessed with the aid of a single plane parameter – the Cobb angle. ![]()
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