Clinical application of back surface topography by means of structured light in the screening of idiopathic scoliosis Laura Pino-Almero a , Maria Fe Mínguez-Rey a,b , Daniel Rodríguez-Martínez a , Rosa M. Cibrián-Ortiz de Anda c , Maria Rosario Salvador-Palmer c and Salvador Sentamans-Segarra d We present the results of the clinical validity in the screening of idiopathic scoliosis with a nonharming method of back surface topography by means of structured light projection. A total of 155 patients were evaluated (mean age 13.3 years). They were divided into two groups: pathologic patients (scoliosis) and nonpathologic patients (control and asymmetries). An analytical case–control study was carried out. Our topographic method obtained 92% sensitivity and 74% specificity as a screening test in identifying patients with scoliosis (P = 0.05). We could quantify the vertebral deformity of scoliosis in the three spatial planes by means of three topographic variables, Horizontal Plane Deformity Index, Posterior Trunk Symmetry Index and Columnar Profile, and to elaborate a combined screening algorithm with good reliability parameters. J Pediatr Orthop B 26:64–72 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Journal of Pediatric Orthopaedics B 2017, 26:64–72 Keywords: diagnosis, kyphosis, Moiré topography, noninvasive methods, scoliosis, spinal curvatures, structured light a Department of Orthopedic Surgery and Traumatology, Clinic University Hospital of Valencia, Departments of b Surgery, c Physiology, University of Valencia, Valencia and d Health Centre of Benicasim, Castellón, Spain Correspondence to Laura Pino-Almero, PhD, Department of Orthopedic Surgery and Traumatology, Blasco Ibáñez Avenue, Number 17, Clinic University Hospital of Valencia, Valencia 46010, Spain Tel: + 34 637 055 775; fax: + 34 961 973 609; e-mail: laupialm@yahoo.es Introduction The American Academy of Orthopaedic Surgeons and the Scoliosis Research Society approved in 1984 the screening of school-age children to detect scoliosis at an early stage. Nowadays, the most used method is the Adams forward- bending test, a qualitative method that evaluates the appearance of an asymmetric hump on the surface of the patient’s back when he/she leans forward. This test can be complemented with a quantitative method that consists of the measurement of the Axial Rotation Angle of the Trunk using a scoliometer [1]. This only evaluates a single com- ponent of the back deformity: the costal hump. Nevertheless, this combined method has a highly variable sensitivity and specificity depending on the type of curve and its location as has been widely reported in the literature [2–4]. Amendt et al. [5] affirms that scoliometer alone is not sufficient to use as a basis for treatment decisions. To overcome these limitations, in recent decades, there has been an emergence of noninvasive optical techni- ques, not based on ionizing radiation, to assess the external morphology of the back. These methods gen- erally consist of the projection of a pattern of parallel stripes or a grid over the back of the patient. In this way, the distortion of the pattern enables, with the proper software, a quantifiable reconstruction of the shape of the patient’s back. One of the first techniques developed was Moiré’s topography [6] in 1970 and, since then, an authentic evolution has occurred with the emergence of different techniques such as the Integrated Shape Investigation System [7], Integrated Shape Investigation System 2 [8], Formetric 4D [9], Orthoscan [10] or the dynamic topography of the surface by Shannon [11]. We present the results of a clinical evaluation of three variables that quantify the back surface topography as a method of screening in scoliosis. The hypothesis of this study is that as spinal deformities have an external manifestation in the topography of the back, quantifica- tion of this topography could enable us to establish a relation with the underlying spinal deformity. Materials and methods Patients A total of 155 patients with a mean age of 13.3 years [7–21] were evaluated and divided into two large groups: Pathologic patients: 88 individuals (14 males and 74 females, mean age 13.19 ± 1.95 years) were diagnosed with scoliosis and presented a positive forward-bending test and a Cobb angle greater than or equal to 10°. Nonpathologic patients: This group was divided into two subgroups: The control group: (54 patients: 44 males and 10 females, mean age 14.47 ± 2.72 years) included those patients who presented a negative forward-bending test with absence of length discrepancy in the lower extremities and, in those patients who underwent a radiographic study, a Cobb angle of 0°. The asymmetry group: (13 patients: four males and nine females, mean age 12.31 ± 2.36 years) included patients 64 Original article 1060-152X Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BPB.0000000000000374 Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved.