Cobb Angle

Cobb Angle: 

 

A healthy spine has three natural curves. It has a rounded S form when viewed from the side. There’s a reason for these natural curves. Simply, it makes the spine stronger, evenly distributes force, and promotes flexibility. As scoliosis progresses, these healthy curves are lost and the spine becomes misaligned. Increased curvatures upset the biomechanics of the entire spine. So, the treatment here at The Southwest Scoliosis and Spine Institute prioritizes curvature and its impact on the entire spine and body. Since scoliosis will inevitably get worse over time and advance more quickly if untreated. The objective of active treatment reduces the curvature of the spine as much as possible.  Our goal restores healthy curves, and to strive toward maintaining those outcomes.

The wide variation in each incidence of scoliosis makes treatment extremely difficult. Scoliosis is a disorder that comes in a variety of forms; thus, no single treatment exists for all cases. Scoliosis X-rays are crucial since they enable us to keep track of the condition’s progression. They also provide us with all the information we want on the specifics of the ailment. This data serves as the foundation for our chosen course of action. Each ailment requires a completely unique treatment plan since they are all unique. The Cobb angle, determined by X-ray, provides crucial details when diagnosing and treating scoliosis.

What is the Cobb Angle?

As was already discussed, the Cobb Angle is a measurement obtained from an X-ray that indicates how much a scoliosis curve is out of alignment relative to a healthy spine. The Cobb angle is expressed in degrees. The greater the Cobb angle, the more serious the problem. The Cobb angle, considered the orthopedic gold standard for scoliosis assessment, provides information on the severity of a patient’s disease, the likelihood that they would have certain symptoms, and the best course of treatment. It is the accepted way to gauge and monitor scoliosis development.

Dr. John R. Cobb initially established the Cobb angle in 1948, outlining how to calculate the angle of the spinal curvature. Thus, the name “Cobb Angle” was given in his honor. The screening for scoliosis before puberty involves forward bending. If this test produces positive results and the Cobb angle is determined, the patient’s treatment plan can be determined.

How to Measure a Cobb Angle?

• Draw a parallel line to the superior vertebral endplate starting at the top of the curve, where the tilted vertebra is located.
• Second, find the vertebra that is most inclined at the base of the curve. Create a parallel line to the inferior vertebral endplate after that.
• Third, construct perpendicular lines that intersect the two parallel lines.
• Last but not least, the Cobb angle becomes the angle created by two parallel lines.

What Does the Cobb Angle Mean In Relation To Scoliosis?

The spine’s curvature becomes quantified in degrees by the Cobb angle. This aids the doctor in deciding on the best course of action. The accepted minimal angulation to identify scoliosis equals a Cobb angle of 10 degrees. Except for routine checkups with the orthopedic specialist, a scoliosis curve of 10 to 15 degrees often does not require any treatment. This continues up until the patient matures and completes puberty. After puberty, the spine’s curvature often does not become worse.

However, an orthopedic doctor will typically recommend a back brace if the scoliosis curve reaches between 20 and 40 degrees. This will prevent the spine from bending much further. There are several varieties of braces available. Some are worn for 18 to 20 hours a day, while others are only worn at night. Depending on the patient’s lifestyle and the degree of curvature, the orthopedic specialist will recommend a certain form of brace(s).

What the Cobb Angle Means for Scoliosis

We can categorize a patient’s condition as mild, moderate, or severe based on the Cobb angle measurement.

Mild Scoliosis

We know that in moderate cases of scoliosis, the symptoms will appear modest and that frequently, only scoliosis specialists who know what to look for will detect them. Because of this, early detection might be difficult. Given that the spine will still have a significant degree of flexibility, making it more manageable, we know that treatment begun earlier in the condition’s progressive course will achieve better results. As the curve progresses, the spine becomes stiffer.  In the mild scoliosis stage, minor postural changes may occur, but likely no functional problems will exist.

Moderate Scoliosis

The intermediate stage of development occurs when the symptoms of scoliosis are most obvious. Uneven shoulders, rib arches, one hip that appears to sit higher than the other, and arms and legs that appear to hang at varying lengths are examples of postural alterations. At this point, the disorder becomes more visible to the typical person, and occasionally gait alterations are also noticeable. At this stage, functional deficiencies are still infrequent, and the patient’s age will also affect the patient’s symptoms.

Additional issues, like pain, may occur at this time, particularly in cases of adult scoliosis. Pain rarely occurs as a problem with the most prevalent kind of illness, adolescent idiopathic scoliosis, because development continues to take place. The curvature of the spine generates compression on the spine and its associated muscles and nerves when the lengthening motion that occurs prior to achieving skeletal maturity ends with skeletal maturity.

Severe Scoliosis

The posture and movement alterations that result from severe scoliosis are obvious and frequently can cause functional impairments and associated problems. Cases of severe scoliosis cause gait alterations, obvious body asymmetry, lung impairment, heart problems, discomfort, headaches, and mobility problems, among other symptoms. Many cases of severe scoliosis have been allowed to continue unchecked, and diagnosis and treatment are only sought after when they are bad enough to cause obvious problems. When the first Cobb angle reading becomes 40 degrees or more, we know that the problem has probably already advanced significantly over time and will require intensive treatment. Additionally, we are aware that a curve has a higher propensity to advance when it’s very high.

Conclusion

Part of diagnosing and evaluating a patient’s condition requires classifying patients based on a number of variables. Along with the patient’s age, curvature location, and type of scoliosis, Cobb’s angle can tell you everything you need to know to treat the condition effectively. Regardless of severity, the sooner treatment starts, the better the prognosis for aggressive treatment. Unfortunately, a cure for Scoliosis does not exist, but the tools exist to treat it.   At The Southwest Scoliosis and Spine Institute, with offices in Dallas, Plano, and Frisco, Texas we tailor each and every treatment plan to suit the specifics of each patient’s condition, such as the Cobb angle and degree of the patient’s disease.

We employ a variety of treatment modalities so that our patients may receive various types of care, and we also refer patients for physical therapy, rehabilitation, and corrective bracing specifically for scoliosis. As we work with a patient during the course of their treatment, we keep track of how they are progressing and adjust the treatment plan as needed based on their condition. If you are in pain, call us to make an appointment.

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Mayo Clinic. Scoliosis & Cobb Angle. 
Spine-Health. Cobb Angle Measurements and Scoliosis. 
Cleveland Clinic. Understanding Scoliosis.