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For many patients, the motivation in seeking treatment is the improvement of their appearance rather than to correct an underlying skeletal deformity, so cosmetic concerns and the psychosocial impacts of scoliosis are important factors in the clinical decision-making process. There is new emphasis on quantifying the components of back surface asymmetry with the objective of producing an agreed scoring to be used in developing treatment plans and assessing results, but to date most techniques continue to rely on either a visual assessment or a single record of the relative positions of anatomical landmarks.
The aim of this study was to establish the effects of posture, breathing and sway on the positions of palpated landmarks over time to determine their efficacy in quantifying cosmetic defect. Five sequential, twenty second (1,200 sample) acquisitions of the three-dimensional locations of six anatomical landmarks were captured from thirty skeletally mature subjects using an optical motion analysis apparatus. The positions of the landmarks were used to derive a measure of the variability of established parameters including spine height, imbalance, trunk inclination, pelvic obliquity, rotation and shoulder droop within and between each acquisition for a given subject. Comparisons were also made between the results obtained from all subjects. The variations observed in the means and standard deviations of each of the parameters over the acquisitions for most subjects, and between subjects, were similar but there were significant differences in the ranges implying that multi-sample analysis offers a better and more reliable measurement of cosmetic symmetry.
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