Cobb angle is generally accepted and used in the literature. Athough it has some drawbacks this classic measuring is routinely used nd that makes the results reported by different authors comparable which is an important advantage.

Hi professor Tanchev

Thank you for answering my question. could you please tell me your idea about this problem that although Cobb angle is used in the literature, we will judge about an angle (like kyphotic angle) just via two vertebra. Is it possible the shape of these two vertebra changes the degree of curves in two different people, whereas the degree of the curves are the same in them.

It is necessary to find vertebral body contours very attentively, thereafter the measurement by the Cobb method is explicit between two or more vertebrae in sagital or frontal plane too. Definitely Cobb angles between vertebrae are affected by individual vertebral shapes or asymetry.  

The measurement is relative, If you consider that ostheoporosis influences on the behaviour of the human spine, any of the reported methods will gave you significant differences.

We are using porcine models in vivo and image correlation hardware in order to study the difference between strain gauges, axial tomography, magnetic resonance, numerical simulation, kinematic software over the video recording.

I think we discuss curve measurement forr practical purpose not for scientific work.

It depends. All colleagues are right. Gold standard doesn't exist. Or you have to develop one or use those above mentioned. From my perspective Cobb technique isn't so precise, but it's widely used for the papers. 

To answer to your second question: Is it possible the shape of these two vertebra changes the degree of curves in two different people, whereas the degree of the curves are the same in them? Yes it is possible, but them observe the whole spine. I'm sure that the spine shape is changed in generally or is even rotated in some place.

What's your idea about measuring with flexicurve. IF you can find the land marks attentively, is it better? because it reflects the shap of whole curve. What method do you prefer? 

From my experience, to use flexicurve, patient has to stand quietly (even than it is hard to obtain measurements accuratelly) or lying on the ventral side. If you can find land marks perfectly than you have it. Try it. You may combine with simple photography from sagittal view as well, but then use reflective markers. To calculate angles between markers is better (more precise, valid) than to use Flexicurve. From my clinical experience I still prefer X ray image with low dosage in standing relaxed posture A-P and sagittal planes with referent scale and markers. After that you'll be able to determine size, sturcture of vertebral bodies, shape, curvature and position but to calculate loads as well. As you can see it depend. Hope this helps, A.

I use the Spinal Mouse system. It is easy to use and shows thoracic, lumbar, and pelvic tilt angles. This system has been validated with radiographic technics. We have several studies with this system. It is not a diagnostic system but you can evaluate the spinal curvatures.

The main problem in my opinion concerning certainty on magnitude of curves is the (too) longstanding focus of the intern. litterature on the "idiopathic"scoliosis and an even longstanding negligence of the importance of what the sagital contour means in clinical view ( posture) A (neuro-) dynamical explanation of 3D deviations was still missed, as is the knowledge on what sagital contour depicts an optimal spinal posture. After the observations, that only sagital reposition of the thoracolumbar joint (Th10-L2) from an unnatural (bad posture) kyphosis towards the natural and functional needed lordosis ( or extension) can correct scoliosis in all three planes new understanding of the interrelationship between anatomic and functional aspects of the other area's has occured. The functional aspects of pathologic curvature are related tot the discongruency of growth between the neural and skeletal systems (Roth) . In a  sitting lifestyle the amount of flexion and thus compression on the ventral part of the spine by the weight of the head of humans in quit an extreme way overweighs the amount of extension ( as in playing, dancing, singing and gymnastic excersises should be delivered) . A contracted and kyphotic TL joint is the precursor of all other secundary curvature. 

measuring the sagital curve between Th10 and L2 apart gives a strong clue on the magnitude of other curves as sown in rsults of \TLI bracing and confirmed by Ni et al from Sjanghai in Spine. 

In our clinique we started to use the Formetric (surface topography, Diers GmbH)) scan to have a true picture of what the human eye can see in assessment of posture and the always related functionality of the spine. For academical research more than common practice the Cobb angle should stay "the language"of spinal deformation. The functionality of the spine in all directions and assesment of the ever present neuromuscular thightness during growth are the tools in common practice. 

In my opinion the answer to the primary question is: the gold standard for spinal curvature measurements is the Cobb angle.

I am agrre with you Prof Tanchev, there are many methods of measurements, but Cobb method is used worldwide to measure and quantify the magnitude of deformity, especially in scoliosis.

Thanks for your answers. Could you please tell me, while my purpose is find the best method for assessment and measurement of spinal curve in subjects with functional (not structural) spinal deformities in order to treat them with corrective exercise protocols, what's your suggestion for the best and safest measuring method? please refer me to valid documents.

Some years ago, Ashton-Miller, Wojtys, and Huston developed an optical method to measure spine curvature.  The technique was eventually used in a study of spine curvature in adolescent athletes.  The photographic study incorporated a unique spine marker (Ashton-Miller, Moga) to assist in the process.

In addition what has already mentioned in this thread, radiographic methods include that of Ferguson.  In addition to Flexicurve, surface methods also include double goniometry and the like.  In our study, we found that optical methods are more comparable to radiographic techniques in the thoracic region, but much less so in the lumbar area.  We hypothesized that this was due to the thickness of the overlying soft tissues, as well as the differences in orientation of surface landmarks (e.g.; spinous processes).

For an overview of methods, please take a look at my doctoral dissertation (Moga PJ, University of Michigan, 2002).

Hope that this is helpful.

Hi Mr.moga

could you please send me some parts of your dissertation that I can get information about the method that is explained by you?

best regards 

I wrote simple program for measurement of Cobb's angle from any pictures on the PC screen. It's for Windows system. It's free on web site www.anglespine.com.

The program would be useful for you.

Thank you Pavel, will spread the word.

thank you so much Pavel and Ricardo.

Considering the methods of spinal curvature measurements I agree that radiographic (Cobb angle) one is widely used in practice however this method gives incomplete data about spatial orientation to call it "gold standard method".In my opinion combination of radiographic measurement and postural characteristic (COG sway velocity) is good enough to properly asses spinal deformities

what is the newest method for measurement of kyphosis and lordosis curves/

Cobb ended his leading article on measuring angles on X ray with the words "I do hope we do not forget scoliosis is much more than an X ray and we forget the clinical examination. The child is more than a X ray. But as Pavel Czerny quoted in this discussion there are free computer-apps in which any person can measure a Cobb angle quit adequately and also easily, even at home on a CD Rom  than the docters should restore the integral examination on form and function to come to more intelligent therapies and prevention.  

In all postural deformations, scoliosis or kyphosis it is not the magnitude on X rays that should be the base for our science or treatment. It is the complete morphology and the strongly to posture related funcionality of the spine. As my study in 40 children showed  the existence of a thoracolumbar kyphosis in any scoliosis ( Spine 2008),  a confirmation  in Spine ( 2011) by a university in Shanghai in a much greater cohort revealed, that the magnitude of that TL kyphosis even predicts the magnitude of the coronal curves means that subsequent measuring the sagital curves ( or a detail of Th10-L2) give much more information as does consequent assesment of contractures in the spine and neuromuscular thightness as can be seen in clinical examination only. Trust your eyes and hands in assessing childrens spines.

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