The relationship between surface and radiological deformity in adolescent idiopathic scoliosis: effect of change in body position.

Three-dimensional (3D) surface deformity of the trunk in adolescent idiopathic scoliosis (AIS) is affected by changes in patient position. Initial quantification of the curve and its associated deformity, as well as subsequent monitoring, relies on both radiological and surface measurements. However, there is often a discrepancy between radiological and apparent surface deformity. The present investigation studied the dynamics of the 3D deformity associated with changes in patient position on 27 patients with AIS. The trunk deformity was quantified in three positions by measuring the angle of thoracic inclination at each vertebral level using a scoliometer. The patients all had full spine radiography in the antero-posterior erect position. Vertebral rotation and lateral spinal curvature were measured from the radiographs. Body position altered the magnitude of the surface deformity over the whole trunk, with the prone position offering the optimum relationship between 3D trunk shape and radiological deformity. This could be attributed to the ease and standardisation of positioning for prone measurements, together with increased patient comfort. It is suggested that adoption of standardised positioning and measurement of surface and radiological deformity will permit consistency of clinical judgement based on these parameters.