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Newfangled Procedures Using X-ray to Determine the Cobb Angle in Patients with Scoliosis: An Updated Systematic Review


Nazila Moftian, Peyman Rezaei Hachesu , Hojjat Hossein Pourfeizi, Taha Sama-Soltani, Nasser Aghazadeh, Masoud Poureisa and Zahra Salahzadeh*   Pages 1 - 11 ( 11 )


Background: Scoliosis is a three-dimensional deformity of the spine. It is usually assessed by measuring Cobb angle. Nowadays, due to increasing effectiveness of image processing and machine vision, willingness to apply these methods has improved considerably in determining scoliosis of Cobb angle.

Methods: In accordance with the PRISMA guideline, a broad electronic search of all English language literature was conducted on the topic through four databases, including MEDLINE, Web of Science, Scopus, and the Cochrane Library from 2012 (last search date from earlier review) to 30 March 2017.

Results: Twelve studies were included. 90% labeled high-quality were selected for analysis. Eighty percent of the selected studies were published in the period between 2012 and 2017. Three new procedures were used to measure the Cobb angle. One study used automated procedure (7%), two studies used smartphone procedure (14%), and nine studies used the semiautomatic procedure of Cobb measurement (79%). Seven studies reported reproducibility and repeatability. Reproducibility range was 0.72 to 1 in reporting of ICC. Repeatability has a high range in three separated methods.

Conclusion: Computerized assessment method (Automatic and Semi-automatic) is most commonly performed in Cobb measurement. Semi-automatic is an effective measurement option for computerized assessment Cobb angle. There is no significant difference between manual, computer- based, and smartphone-based methods in described measures.


Spine, scoliosis, diagnostic imaging, image processing, computer-assisted, radiography, decision support systems.


Tabriz university of medical science, Health information technology, Tabriz university of medical science, Health information technology, Tabriz university of medical science, Shohada Hospital, Tabriz university of medical science, Health information technology, Azarbaijan Shahid Madani University, Image Processing Laboratory, Tabriz university of medical science, Faculty of Medicine, Tabriz university of medical science, Department of Physiotherapy, Faculty of Rehabilitation

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