title: Influence of Cobb Angle and ISIS2 Surface Topography Volumetric Asymmetry on Scoliosis Research Society-22 Outcome Scores in Scoliosis.
abstract: METHODS
  Retrospective sequential patient series.
  
  
  OBJECTIVE
  To establish the relationship between the magnitude of the deformity in scoliosis and patients' perception of their condition, as measured with Scoliosis Research Society-22 scores.
  
  
  METHODS
  A total of 93 untreated patients with adolescent idiopathic scoliosis were included retrospectively. The Cobb angle was measured from a plain radiograph, and volumetric asymmetry was measured by ISIS2 surface topography. The association between Scoliosis Research Society scores for function, pain, self-image, and mental health against Cobb angle and volumetric asymmetry was investigated using the Pearson correlation coefficient.
  
  
  RESULTS
  Correlation of both Cobb angle and volumetric asymmetry with function and pain was weak (all < .23); these correlation values were not statistically significant. Correlation of Cobb angle and volumetric asymmetry with self-image, was higher, although still moderate (-.37 for Cobb angle and -.44 for volumetric asymmetry). Both were statistically significant (Cobb angle, p = .0002; volumetric asymmetry; p = .00001). Cobb angle contributed 13.8% to the linear relationship with self-image, whereas volumetric asymmetry contributed 19.3%. For mental health, correlation was statistically significant with Cobb angle (p = .011) and volumetric asymmetry (p = .0005), but the correlation was low to moderate (-.26 and -.35, respectively). Cobb angle contributed 6.9% to the linear relationship with mental health, whereas volumetric asymmetry contributed 12.4%.
  
  
  CONCLUSIONS
  Volumetric asymmetry correlates better with both mental health and self-image compared with Cobb angle, but the correlation was only moderate. This study suggests that a patient's own perception of self-image and mental health is multifactorial and not completely explained through present objective measurements of the size of the deformity. This helps to explain the difficulties in any objective analysis of a problem with multifactorial perception issues. Further study is required to investigate other physical aspects of the deformity that may have a role in how patients view themselves.
authors.affiliation: Spinal Deformity Unit, Royal Orthopaedic Hospital, Northfield, Birmingham B31 2AP, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Brewer
authors.affiliation: Spinal Deformity Unit, Royal Orthopaedic Hospital, Northfield, Birmingham B31 2AP, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Berryman
authors.affiliation: Spinal Deformity Unit, Royal Orthopaedic Hospital, Northfield, Birmingham B31 2AP, United Kingdom.
authors.forename: De
authors.lastname: Baker
authors.affiliation: Spinal Deformity Unit, Royal Orthopaedic Hospital, Northfield, Birmingham B31 2AP, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Pynsent
authors.affiliation: Spinal Deformity Unit, Royal Orthopaedic Hospital, Northfield, Birmingham B31 2AP, United Kingdom. Electronic address: Adrian.gardner@nhs.net.
authors.forename: Adrian
authors.initials: A
authors.lastname: Gardner
keywords: Cobb angle; SRS-22 questionnaire; Scoliosis; Volumetric asymmetry