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The authors report a radiographic method for measuring the axial rotation of vertebrae in degrees and its use in 99 patients with adolescent idiopathic scoliosis. The offset of the pedicle images from the vertebral body center and a “depth” estimate measured radiographically in a population of patients with scoliosis permitted calculation of axial rotation by means of a simple mathematical formula. It was found that measurements of vertebral rotation can be made clinically from single-plane radiographs with a standard deviation of 3.6° (95% confidence limit ±7.1°) based on a study of known rotations of a radiographic phantom, and with a standard deviation of 2.44° (95% confidence limit ±4.8°) based on comparisons with three-dimensional measurements of the orientation of each vertebra derived from low-dose stereo films of a group of patients. Measurements from clinical films are unlikely to be made more accurately than this, because of inherent geometric constraints.