The Study: Upright, prone, and supine spinal morphology and alignment in adolescent idiopathic scoliosis.  

The Facts:

  1. This study compared the “coronal, axial, and sagittal morphology of the scoliotic spine” using upright plane film radiography, prone CT and supine MRI.
  2. The subjects were 62 adolescent idiopathic scoliosis patients who had been scheduled for surgery.
  3. The authors noted that x-rays for scoliosis have traditionally been taken in the upright position.
  4. They also noted concerns over x-ray radiation and that the 3-D nature of scoliosis is difficult to appreciate on conventional x-rays.
  5. The authors state that while ultrasound imaging is promising, it gives little detail of the anatomy and that further study is needed.
  6. The authors found that while imaging in the supine and prone positions did underestimate the magnitude of scoliotic deformity as compared to the upright position there was still “a significant correlation” with the findings on supine CT and MRI.

 Take Home: Supine imaging with CT and prone MRI as used in this study tend to significantly underestimate curvature severity as compared to standing radiographs. Cobb angles on standing radiographs provide the most accurate information as to curve magnitude. Advanced imaging (CT/MRI) can be helpful in better appreciating the three dimensional nature of scoliosis.

 Reviewer’s Comments:

It would seem that most DCs would probably wish to have the most accurate knowledge of both the nature and magnitude of scoliosis. In order to do this practitioners should be ever mindful that radiographs are projections, not pictures. Advanced imaging procedures may be helpful as well. Practitioners should be aware that if you are using imaging not obtained in the upright position then the magnitude of the scoliosis is likely to be reduced.

 Reviewer: Roger Coleman DC

Reference: Brink RC, Colo D, Schlosser TPC et al.  Upright, prone, and supine spinal morphology and alignment in adolescent idiopathic scoliosis. Scoliosis Spinal Disord 2017 Feb 22;12:6. doi: 10.1186/s13013-017-0111-5. eCollection 2017.


Link to Abstract: