The Cobb angle measures spinal curvature in scoliosis or spinal fractures, but has drawbacks. It is a quick diagnostic tool, but can be inaccurate and does not account for twisting of the spine. Consultation with multiple doctors is recommended for treatment decisions.
The Cobb angle is a measure used to determine the degree of curvature in a patient with scoliosis or in someone who has suffered a spinal fracture leading to curvature. This measurement method has some drawbacks that must be considered when using it as a tool for diagnosis and treatment. The Cobb angle, as it is also known, is relatively easy to evaluate and can be a useful quick diagnostic tool when coupled with a physical exam of the patient.
To determine the Cobb angle, an x-ray of the spine is taken, looking at the patient from behind. The healthcare professional identifies the beginning and end of the curve and draws lines from the vertebrae to the beginning and end of the curve. In a person with a straight spine, these lines would be parallel. In people with spinal curvatures, the lines follow the angle of the vertebrae and are angled.
Perpendicular lines are drawn from these lines until they intersect. The Cobb angle is the angle at the point of intersection. Depending on the severity of the angle, a doctor may recommend the use of a brace or may tell the patient that surgery is needed to correct the curvature. One problem with the Cobb angle is that people can be four to six degrees off when they take the measurement. This can mean the difference between bracing and surgery, making it a pretty critical mistake.
Additionally, this measurement treats the spine as a two-dimensional object on an X-ray, when the spine actually exists in three dimensions. The Cobb angle does not account for the twisting of the spine that often accompanies the development of a side-to-side curvature. A patient might have a small Cobb angle, but a severely distorted spine. One way to explain this is to refrain from recommending treatment based solely on the Cobb angle, instead using information from multiple sources when making decisions about treatment and management of spinal curvature.
Patients with scoliosis of the spine or spinal curvatures caused by trauma usually work with a spine expert for treatment. It can be helpful to consult with several doctors for further advice, as treatment philosophies can be quite variable. When treatments are recommended, it is important to ask yourself how the treatment will be performed, why it is being recommended, and what alternatives are available. This will help patients make an informed decision about treatment.
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