title: Assessing kyphosis with SpineScan: another attempt to reduce our dependence on radiography.
abstract: BACKGROUND
  Kyphosis management is mainly conservative, with annual examinations to assess angular progression. This includes physical examination and usually long spine X-rays, notorious for ionizing radiation. Several nonradiological instruments have been devised for this, but none have become popular. SpineScan, a programmed digital inclinometer, has been proved effective for screening kyphoscoliosis.
  
  
  OBJECTIVE
  The aim of this study was to assess the accuracy of SpineScan in monitoring kyphosis.
  
  
  METHODS
  Prospective, observational, diagnostic accuracy study.
  
  
  METHODS
  Twenty-eight subjects examined for kyphosis, with recent full-length lateral spine X-rays.
  
  
  METHODS
  Each subject was examined by two examiners. The technique involved the subject standing with arms flexed to 90° and then sliding the SpineScan from just below C7 to L2. Maximum X-ray kyphotic Cobb angle was compared with the SpineScan result. The study was institutional review board approved, and all patients signed an informed consent.
  
  
  RESULTS
  The mean Cobb angle of the 28 subjects on radiography was 51° ± 15°. The mean SpineScan angle of all trials of all examiners was 54° ± 12°. The difference between the two measurements was significantly different from zero (3.2° ± 9.4°, p<.0001) and not normally distributed. The difference was significantly affected by the Cobb angle, examiner, and interaction between Cobb and examiner (statistical significance for all p<.0001). Ninety-five percent confidence intervals for all examiners ranged between -16° and 22° and for separate examiners between -25° and 32°, far above the 5° preplanned error level.
  
  
  CONCLUSIONS
  The results demonstrated that there is significant error in monitoring kyphosis with SpineScan. Even for a more modest indication including replacing radiography with SpineScan on alternate visits, the measurement was not accurate enough. Future research is necessary to find a nonradiographic method of kyphosis follow-up, possibly using a digitalized modification of one of the described instruments.
authors.affiliation: Department of Orthopaedic Surgery, Assaf Harofeh Medical Center, PO Beer Yaacov, Zerifin, Tel Aviv, 70300, Israel. asff@inter.net.il
authors.forename: Aharon S
authors.initials: AS
authors.lastname: Finestone
authors.forename: Gil
authors.initials: G
authors.lastname: Marcus
authors.forename: Yoram
authors.initials: Y
authors.lastname: Anekstein
authors.forename: Yigal
authors.initials: Y
authors.lastname: Mirovsky
authors.forename: Gabriel
authors.initials: G
authors.lastname: Agar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods*; D011187:Posture / Q000502:physiology; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012600:Scoliosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D012720:Severity of Illness Index; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000502:physiology*
keywords: Back deformity; Digital inclinometer; Radiation; Scheuermann kyphosis; Screening