Is Cobb angle progression a good indicator in adolescent idiopathic scoliosis?

Spine (Phila Pa 1976). 2002 Mar 15;27(6):E145-51. doi: 10.1097/00007632-200203150-00009.


Study design: A retrospective follow-up study of spine geometry after posterior instrumentation and fusion for adolescent idiopathic scoliosis (AIS).

Objectives: To evaluate 1) if Cobb angle progression is a reliable indicator of the crankshaft phenomenon; 2) if significant growth of the spine can occur after surgery without the development of a crankshaft phenomenon?

Summary of background data: Anterior fusion of the spine is often recommended for skeletally immature scoliotic patients to avoid the risk of a crankshaft phenomenon, a long-term loss of curve correction caused by residual growth of the spine combined with the constraints of a posterior fusion. The crankshaft phenomenon is usually assessed indirectly by documenting progression of the Cobb angle on frontal radiographs. Thus far, no study has directly measured the three-dimensional growth of the spine after surgery in AIS.

Methods: Cobb angle, spine length and spine height were obtained from three-dimensional radiographic reconstructions of the spine in 48 adolescent scoliotic patients undergoing posterior instrumentation and fusion. Measurements were done before surgery, after surgery and at skeletal maturity. A significant growth of the spine was defined as a > or = 10 mm increase in spine length, while a significant curve progression was defined as a > or = 10 degrees increase in Cobb angle at skeletal maturity.

Results: In the majority of patients (56%), there was no significant change in spinal length or in Cobb angle measurements at an average 2.4 years post surgery. A crankshaft phenomenon was detected in 6 patients (12%) for which significant increases both in spinal length and Cobb angle measurement were found. Significant curve progression without any change in spine length was noted in 9 patients (19%) while an increase in spine length with no evidence of curve progression was present in 6 patients at last follow-up.

Conclusion: Spinal growth as indicated by an increase in spinal length can be measured in a significant proportion of adolescents with idiopathic scoliosis after posterior instrumentation and fusion. Some of these study participants will develop a crankshaft phenomenon but Cobb angle progression is not a reliable indicator of this complication, since it may occur without any detectable growth of the spine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Cohort Studies
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Kyphosis / diagnosis
  • Kyphosis / surgery
  • Lordosis / diagnosis
  • Lordosis / surgery
  • Male
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / etiology
  • Predictive Value of Tests
  • Radiography
  • Retrospective Studies
  • Risk Factors
  • Scoliosis / diagnosis*
  • Scoliosis / surgery
  • Spinal Fusion / adverse effects
  • Spine / diagnostic imaging*
  • Spine / growth & development*
  • Spine / surgery
  • Treatment Outcome