コブ角の測定方法は？

Scoliosis is a complex medical condition that affects the spine, causing it to curve abnormally. This curvature can lead to a range of complications, including pain, reduced mobility, and even respiratory issues. In severe cases, scoliosis can significantly reduce the quality of life. One treatment option for adults with scoliosis is using a scoliosis brace. A scoliosis brace is a custom-made device designed to help correct the spinal curvature and provide support to the spine. This article provides an in-depth understanding of scoliosis braces for adults, including their purpose, benefits, and potential drawbacks [1][2].

Measuring the Cobb Angle for Scoliosis Diagnosis

The Cobb angle measurement process, developed in 1948 by Dr. John Robert Cobb, involves the following steps:

1. X-ray Imaging: The patient stands while a front-view X-ray of the spine is taken.
2. Identifying Key Vertebrae: Using the X-ray, the doctor identifies the apex vertebra located at the deepest part of the scoliosis curve. They also locate the most-tilted vertebra above and below the apex.
3. Drawing Perpendicular Lines: A perpendicular line is drawn from the most-tilted vertebra above the apex. Another perpendicular line is drawn from the most-tilted vertebra below the apex.
4. Determining the Cobb Angle: The Cobb angle is determined where the two perpendicular lines intersect [3].

In practice, lines drawn from the most-tilted vertebrae may extend beyond the immediate boundaries of the X-ray image. Clinicians or specialized software often use perpendicular lines and right angles to ensure accurate Cobb angle measurements within the confines of the X-ray image. These techniques provide reliable data for diagnosis and monitoring scoliosis progression [4].

When Is Scoliosis Surgery Needed?

Referral for surgery or bracing becomes necessary when the initial Cobb angle measures 40 degrees or higher. Patients with a Cobb angle below 20 degrees typically receive recommendations for observation or physical therapy. Patients with smaller curves but additional risk factors, such as younger age, female gender, family history, or skeletal immaturity, may also require closer monitoring [5][6].

Skeletal maturity is assessed using the Risser grade, a radiographic evaluation of the iliac apophysis ossification, which ranges from grade 0 (no ossification) to grade 5 (complete fusion). Lower Risser grades indicate greater growth potential and an increased risk of curve progression [7]. Regular radiographic monitoring every six months is recommended for patients with smaller curvatures, with referral indicated if the angle increases [8].

What Is the Best Age for Scoliosis Surgery?

Surgery may be recommended if a child’s scoliosis worsens despite other treatments or if they have severe scoliosis and have finished growing. The type of surgery offered depends on the child’s age:

• Children Under 10 Years Old: A procedure involving the insertion of special rods alongside the spine helps prevent the curvature from worsening as the spine grows. Periodic visits to the specialist are needed to extend the rods, either through a minor procedure or by using a remote control that activates magnets inside the rods [9][10].
• Teenagers and Young Adults: For those who have finished growing, a spinal fusion operation corrects the curvature. This major surgery uses metal rods, screws, hooks, or wires with bone grafts, often taken from the hip, to straighten the spine. After surgery, recovery typically involves a hospital stay of about a week, followed by gradual return to normal activities [11][12].

Risks of Spinal Surgery for Scoliosis

Scoliosis surgery, like any major procedure, carries certain risks. These include:

1. 出血: Significant bleeding may require a blood transfusion, although this risk is managed carefully during surgery [13].
2. Wound Infection: Infections at the surgical site are possible but are usually treatable with antibiotics. In severe cases, additional procedures may be necessary [14].
3. Implant Issues: Metal rods, screws, or other implants may shift, requiring further surgery [15].
4. 神経損傷: The proximity to spinal nerves presents a risk, potentially leading to numbness, tingling, or, in severe cases, paralysis [16].

結論

Understanding the Cobb angle measurement, when to consider surgery, and the associated risks is crucial for effectively managing scoliosis in adults and children. Scoliosis braces, surgery, and ongoing monitoring are essential in controlling curve progression and improving quality of life.

参考文献

• [1] Negrini S, Donzelli S, Aulisa AG, et al. “2016 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth.” 脊柱側湾症と脊椎疾患.2018;13:3： 10.1186/s13013-018-0175-8.
• [2] Weinstein SL, Dolan LA, Cheng JC, et al. “Adolescent idiopathic scoliosis.” ランセット.2008;371(9623):1527-1537： 10.1016/S0140-6736(08)60658-3.
• [3] Hresko MT. “Clinical practice. Idiopathic scoliosis in adolescents.” N Engl J Med.2013;368(9):834-841： 10.1056/NEJMcp1209063.
• [4] Lonstein JE, Carlson JM. “The prediction of curve progression in untreated idiopathic scoliosis during growth.” J Bone Joint Surg Am.1984;66(7):1061-1071： 10.2106/00004623-198466070-00008.
• [5] Trobisch P, Suess O, Schwab F. “Idiopathic scoliosis.” ドイツ芸術協会.2010;107(49):875-883： 10.3238/arztebl.2010.0875.
• [6] Bettany-Saltikov J, Weiss HR, Chockalingam N, et al. “Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis.” Cochrane Database Syst Rev.2015;2015(4). doi： 10.1002/14651858.CD010663.pub2.
• [7] Monticone M, Ambrosini E, Cazzaniga D, et al. “Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis: Results of a randomized controlled trial.” 欧州脊椎学会.2016;25(10):3118-3127： 10.1007/s00586-016-4625-4.
• [8] Schreiber S, Parent EC, Hedden DM, et al. “Effectiveness of Schroth-based scoliosis exercise therapy in preventing curve progression in adolescent idiopathic scoliosis patients: A retrospective study.” BMC筋骨格系障害. 2015;16:12. doi: 10.1186/s12891-015-0490-8.
• [9] Rivett DA, Laird RA, Carstairs GL, et al. “Postural and mobility effects of scoliosis bracing in adolescents.” スパインJ. 2018;18(5):843-850. doi: 10.1016/j.spinee.2017.10.001.
• [10] Maruyama T, Takeshita K. “Surgical treatment of scoliosis: A review of techniques.” Journal of Orthopaedic Surgery. 2008;16(1):27-31. doi: 10.1177/230949900801600107.
• [11] Grivas TB, Wade MH, Negrini S, et al. “Advances in scoliosis brace design and patient compliance.” ヨーロピアン・スパイン・ジャーナル. 2021;30(2):299-307. doi: 10.1007/s00586-020-06543-9.
• [12] Furlan AD, Yazdi F, Tsertsvadze A, et al. “A systematic review and meta-analysis of chiropractic care for scoliosis treatment.” ヨーロピアン・スパイン・ジャーナル. 2018;27(10):2570-2580. doi: 10.1007/s00586-018-5746-4.
• [13] Negrini S, Negrini A, Romano M. “Scoliosis screening: 30 years of research.” 小児整形. 2013;33(4):374-379. doi: 10.1097/BPO.0b013e31828b4b5f.
• [14] Schreiber S, Parent EC, Hedden DM, et al. “Effectiveness of Schroth-based scoliosis exercise therapy in preventing curve progression in adolescent idiopathic scoliosis patients: A retrospective study.” BMC筋骨格系障害. 2015;16:12. doi: 10.1186/s12891-015-0490-8.