As a parent or patient with AIS, you want to be able to answer questions like:
- Is a curve progressing?
- Is it progressing more during growth periods?… how much per inch of growth?
- How effective is a new brace?
- Is a brace effective for all components of the curve, or curves?
- Is the trunk rotation changing?
To be prepared to answer these, and more, I recommend keeping a spreadsheet with the following items. I’ll provide some explanation of the less obvious items further below.
- Height, at least monthly (in and out of brace)
- Weight, at least monthly (out of brace)
- Cobb angles
- Cobb angle component parts
- Trunk rotations (Thoracic and Lumbar if applicable)
- Hip Height Discrepancy, if any
- Brace effectiveness percentage(s) for each curve
*Also capture important milestones such as getting a new brace, etc.
About Cobb Angles
At some point, I’ll do a post on how you can measure Cobb angles for yourself. Meanwhile, you should track every Cobb angle measure provided by your doctor. And, of course, if you have an “S” curve, you’ll have two Cobbs per x-ray to track. Be sure to always note whether they are in or out of brace.
Cobb Component Angles
Though everyone talks about Cobbs, few consider their component parts. A single cobb angle, for example, is comprised of two angles… the upper and lower. An “S” curve has three angles. These are the upper thoracic, transitional, and lower lumbar.
I measure these as relative to 90 degrees from a vertical line. In the below example, from one of my daughters’ x-rays, the upper thoracic is 101°. The transitional is 102°, and the lower lumbar is 99°. The upper and transitional comprise a 23° thoracic Cobb ((101-90)+(102-90)) while the transitional plus lower lumbar make for a 21° lumbar Cobb ((102-90)+(99-90)).
(Note: I admit, with the above, that my confidence level is lowest on the upper thoracic angle due to the “blurring” effect caused by the spinal rotation in the area. It’s hard to get a clear alignment to the vertebra tops or bottoms)
Why care about the component angles? We recently got new braces. When we first got in-brace x-rays for Bella (a pseudonym), it appeared we were getting very good correction of her thoracic Cobb. But, upon closer inspection, I found that only her upper thoracic component angle was impacted because the brace was forcing her shoulder up. Both her transitional and lower lumbar angles were completely unaffected by the brace. Putting this another way, the lower part of her thoracic curve wasn’t being helped and her lumbar curve wasn’t helped at all. Breaking this down into components really helped us understand what was happening. The orthotist ended up making significant adjustments such that all component angles were, later, shown to be improved.
When I show how to do your own cobb angles, you’ll be able to capture the components for yourself. Otherwise, you’ll need to see if the doctor is willing to provide these.
How to measure trunk rotations (e.g. with a scoliometer) is described in the post on screening. Just keep in mind that you may have a rotation in lumbar area as well as the thoracic area, so measure both regions.
An example of my notation for trunk rotation is 9°+L, which means the rotation angle is measured at 9° with the higher side being on the Left.
Hip Height Discrepancy
Also known as leg length discrepancy, because it appears as such though the problem may not be with the legs, scoliosis is often accompanied by an apparent imbalance of the legs or hips, resulting in an “uneven foundation” for the spine. One of my girls has a 1cm discrepancy which is fairly substantial. It’s a material data point so I track it.
This is typically measured by comparing the tops of the left and right ilium (iliac crest). My notation example: .8cm +L means the top of the left ilium is .8cm higher than the right.
Using measures from in-brace x-rays, I calculate the effectiveness of a brace on each curve relative to the last out of brace x-ray of that curve, as a percentage. I simply label the Thoracic and Lumbar correction columns as T% Correct and L% Correct, respectively.
Example Tracking Sheet
Slightly modified for illustration, the below is an example excerpt of the spreadsheets I’m keeping for my daughters. I’ve chopped this into two tables to fit below and maintain readability.
Of course, you can track whatever you want however you want. This is just how I choose to do it.
Disclaimer: I am not, in any way, medically trained and you should seek professional medical advice before making any decisions based on information found here.