Abstract
Background: It is generally accepted that surgical correction in adolescent idiopathic scoliosis (AIS) is largely for cosmesis. Scoliometer measurements of back surface asymmetry and rasterstereographic methods are used to attempt to quantify the surface deformity, These methods are also used to determine the ‘success’ of surgery. This study objectively evaluates trunk cosmesis from pre-operative photographs.
Methods: This is a prospective cohort study. Twelve pre-operative girls with thoracic AIS had standard photographs taken in the standing and forward bending positions. The mean Cobb angle is 74°, mean age 13.7 years. Twenty observers were selected by their profession (3 Spinal Consultants, 4 Orthopaedic Specialist Registrars, 4 nurses, 4 medical illustrators and 5 lay-people). Each patient’s photographs were arranged on a single sheet and the observer was asked to arrange the patients in order of cosmesis and having done this to give a score between 0 (best) and 100 (worst) for overall cosmesis.
Results: There was no good agreement either in the ranking or the scoring for any of the groups of observers. Some observers agreed quite well whilst others ranked and scored much differently to the ‘mean’.
Conclusion: Cosmesis is a spectrum and is most definitely in the eye of the beholder with wide disagreement between individuals both for ranking and scoring cosmesis. We must identify the components of trunk cosmesis (for the majority of observers) so that we can quantify these and produce a score to reflect what we are trying to treat. Only then will we be able to assess the results of our treatments.
The abstracts were prepared by Mr Colin E. Bruce. Correspondence should be addressed to Colin E. Bruce, Consultant Orthopaedic Surgeon, Alder Hey Children’s Hospital, Eaton Road, Liverpool, L12 2AP.
