ArticleSpine deformity2026
Rib flare distance: a novel and highly reliable radiographic metric of the rib cage deformity in adolescent idiopathic scoliosis.
Article in Spine deformity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeRib cage deformity in adolescent idiopathic scoliosis (AIS) is an axial plane deformity with significant implications for pulmonary function and cosmetic appearance. However, this plane is historically cumbersome to measure on standard radiograph, severely limiting our ability to study the deformity. Clinicians commonly rely on the scoliometer or rib vertebra angle difference (RVAD), which suffer from limited reproducibility. This study proposes and evaluates the rib flare distance (RFD) as a novel radiographic metric of the rib cage deformity in AIS.
methodsA retrospective analysis included 40 AIS patients and 20 controls. Two independent observers measured RFD; one observer repeated measurements for intra-observer testing. Intraclass correlation coefficients (ICC) assessed reliability. Bland-Altman analysis evaluated variability and agreement. ROC analysis tested the ability of RFD to discriminate AIS patients from controls. Correlations with established metrics of AIS evaluated its clinical relevance.
resultsRFD exhibited excellent inter- and intra-observer reliability (ICC = 0.986; 0.993), low variability (2.4 mm; 1.8 mm), and strong agreement. Further, it demonstrated excellent discriminatory ability (area under the curve = 0.941). RFD correlated moderately with thoracic Cobb angle (r = 0.544) and RVAD (r = 0.409), and weakly with scoliometer (r = 0.326) and Nash Moe (r = 0.334).
conclusionRFD is a highly reproducible and discriminative radiographic metric that may provide a valuable adjunct to existing tools. Radiographic assessment of the rib cage deformity remains underutilized, and RFD may fill this gap, enhancing three-dimensional characterization of AIS.
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