What radiographic parameters should be assessed on the PA radiograph

Identify the end vertebra, apical vertebra, curve location, curve direction, curve magnitude, and Risser sign.

• End vertebra. The top and bottom vertebra that tilt maximally into the concavity of the curve are termed the end vertebra. They are typically the least rotated and least horizontally displaced vertebra within the curve

• Apical vertebra. The apical vertebra is the central vertebra within a curve. It is typically the least tilted, most rotated, and most horizontally displaced vertebra within a curve

• Curve location. The curve location is defined by its apex

Curve Apex

Cervicothoracic C7 or T1

Thoracic Between T2 and T11-T12 disc

Thoracolumbar T12 or L1

Lumbar Between L1-L2 disc and L4

Lumbosacral L5 or S1

• Curve direction. Curve direction is determined by the side of the convexity. Curves convex toward the right are termed right curves, while curves convex to the left are termed left curves

• Curve magnitude. The Cobb-Lippman technique is used to determine curve magnitude. Perpendicular lines are drawn in relation to reference lines along the superior endplate of the upper end vertebra and along the inferior endplate of the lower end vertebra. The angle created by the intersection of the two perpendicular lines is termed the Cobb angle and defines the magnitude of the curve (also see Chapter 10, Fig. 10-12)

• Risser sign. The Risser sign describes the ossification of the iliac apophysis. The iliac crest is divided into quarters, and the stage of ossification is used as a guideline to assess skeletal maturity: grade 0: absent, grade 1 (0-25%), grade 2 (26%-50%), grade 3 (51%-75%), grade 4 (76%-100%), grade 5 (fusion of apophysis to the ilium). Risser stage 4 correlates with the end of spinal growth in females, and Risser stage 5 correlates with the end of spinal growth in males (Fig. 39-2)

Figure 39-2. Measurement for idiopathic scoliosis. A, Note the Cobb angle. B, Harrington's stable zone. C, Moe's neutral vertebra, Risser staging, and the center sacral line (dashed line). (From Stefko RM, Erickson MA. Pediatric orthopaedics. In: Miller MD, editor. Review of Orthopaedics. 3rd ed. Philadelphia: Saunders; 2000.)

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