Trunk distortion in adolescent idiopathic scoliosis

Trunk images of children with scoliosis were examined to determine features that contribute to the impression of trunk distortion. Twenty subjects with spinal deformity ranging from none to severe were photographed in a relaxed standing position. Seven blinded evaluators subjectively scored their impressions of the trunk appearance, shoulder-height difference, shoulder-angle asymmetry, decompensation, scapula asymmetry, waist crease, waist asymmetry, and pelvic asymmetry. Regression analysis was used with the latter seven features to predict overall impression. The seven measures of the deformity predicted 85% of the overall impression of trunk distortion; scapular asymmetry was the best predictor. Trunk deformity is the most obvious effect of scoliosis to the patients. Objective approaches to the assessment of this important but difficult-to-quantify aspect of idiopathic scoliosis are available and should be used to evaluate treatment outcomes.