PURPOSE Clinical photography has proven to be reliable for posture assessment in adolescents and young adults with idiopathic scoliosis. This paper attempts to elucidate whether clinical photography is capable of distinguishing the distinctive characteristics in trunk deformity of the different Lenke patterns in patients with severe scoliosis candidate for surgery. METHODS One hundred and seventy-three patients (82% women), average age of 20.8 years and average largest curve magnitude of 58.7° were included. PA standing full-spine X-rays and digital photographs from the back of the trunk were measured. RADIOLOGICAL MEASUREMENTS It is used to measure magnitude of the proximal thoracic (PTC), main thoracic (MTC) and thoracolumbar/lumbar (TL/LC) curves, T1 tilt and the clavicle-rib intersection angle. PHOTOGRAPHIC MEASUREMENTS It is used to measure shoulder height angle, axilla height angle, waist height angle (WHA), right and left waist angles and trunk areas. STATISTICAL ANALYSIS One-way ANOVA to test mean differences among Lenke types for radiological and photographic measurements was performed. ROC curve analysis was conducted to find out cutoff values in photographic measurements to differentiate among curve patterns. RESULTS Most radiological and photographic measurements differ among curve patterns. On ROC curve analysis, solid cutoff values were found for WHA (AUC = 0.8), left waist angle (AUC = 0.81), right waist angle (AUC = 0.81) and the difference between left and right waist angles (AUC = 0.86) to differentiate between types 1 and 2 and the other three types (3, 5 and 6). CONCLUSIONS Clinical photography is a valid method for assessing trunk asymmetry in severe idiopathic scoliosis. Specifically, for waist area measurements, robust cutoff values can be determined to discriminate among different curve patterns according to Lenke classification. These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

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重度特发性脊柱侧凸候选手术的临床摄影：这是区分Lenke模式的有用工具吗？

目的临床摄影已被证明可用于青少年和特发性脊柱侧弯的年轻人的姿势评估。本文试图阐明临床摄影是否能够区分患有严重脊柱侧弯的手术患者的不同Lenke模式的躯干畸形的特征。方法纳入173例患者（82％的女性），平均年龄20.8岁，平均最大弯曲幅度58.7°。测量了PA站立的全脊柱X射线和来自躯干背面的数码照片。放射学测量它用于测量胸廓近端（PTC），主胸廓（MTC）和胸腰/腰椎（TL / LC）曲线的大小，T1倾斜度和锁骨-肋骨相交角。摄影测量它用于测量肩高角，腋高角，腰高角（WHA），左右腰角和躯干区域。统计分析进行了单向方差分析以测试Lenke类型之间在放射学和照相测量方面的均值差异。进行ROC曲线分析以找出摄影测量中的临界值以区分曲线模式。结果大多数放射线和照相测量值在曲线样式之间有所不同。在ROC曲线分析中，发现WHA（AUC = 0.8），左腰角（AUC = 0.81），右腰角（AUC = 0.81）和左右腰角之间的差（AUC = 0.86）的实测截止值区分类型1和2，以及其他三种类型（3、5和6）。结论临床摄影是评估严重特发性脊柱侧凸的躯干不对称的有效方法。具体而言，对于腰围区域测量，可以根据Lenke分类确定可靠的截止值，以区分不同的曲线模式。这些幻灯片可以在电子补充材料下找到。