Is surface topography useful in the diagnosis of scoliosis? : Validation of the Biometrical Holistic Of Human Body (BHOHB)

Angelo Gabriele Aulisa1 , Diletta Bandinelli1 , Francesco Falciglia1 , Marco Giordano1 , Renato Maria Toniolo1

1) U.O.C. Orthopaedics and traumatology, Children Hospital Bambin Gesù, Rome


To date, the gold standard for scoliosis diagnosis and surveillance in children’s spinal deformity is standing full-column radiographs, but repeated exposure to X-rays motivates all physicians involved in scoliosis to find a new solution. One of them is the modern system of surface topography (ST).

Research Question
The aim of the study is to validate the new BHOHB technology for the diagnosis of scoliosis in children respect to radiographic examination and evaluate the reliability of intra-operator and inter-operator.


113 Consecutive patients affected by idiopathic Scoliosis were examinate in our study. Inclusion criteria were age 10-18; diagnosis of scoliosis measuring ≥10, positive adam’s test and no prior treatment with brace. 

Standing radiographs and back surfaces of the patients with the BHOHB (Banyan Technologies GmbH, Maestrale Information Technology SRL) were obtained on all patients. All patients were analysed, with BHOHB, twice by two independent operators (t0) and once again after 2/3 months (t1). The examination consisted in positioning the patient on a special platform after placing 11 markers in pre-set points of the trunk.

The correlation between the measurements made with BHOHB and the gold standard was expressed by the Pearson correlation coefficient. The intra and inter-operator reliability was assessed using the intraclass correlation coefficient (ICC). The analysis was carried out with the GraphPad Prism 8 software.


A total of 95 patients were enrolled. The mean age was 12.51 years. The scoliosis magnitude was 20.54 ± 9 Cobb degrees. The measurements in Cobb degrees obtained at t0 with the BHOHB by the first operator were 20.87 ° (± 9.1 SD), while those of the second were 20.82 ° (± 8.67 SD). Instead at t1 were respectively 20.23 ° (± 8.93 SD) and 19.90 ° (± 8.96 SD). 

The average hump measured with the humpmeter was 6.11 mm (± 5.14 SD) while that measured with the BHOHB was 6.58 mm (± 4.94 SD) and the correlation was significant (r=0.94; p <0.0001).

The correlations between the measurements made with the BHOHB and radiography showed a very good to excellent r for both the first and second operators. In particular:  X-rays vs 1st operator at t0 r = 0.9846; X-rays vs 2nd operator at t0 r = 0.9791; X-rays vs 1st operator at t1 r = 0.9745; X-rays vs 2nd operator at t1 r = 0.9563.


The intra-operator reliability was evaluated by ICC and was found to be very reliable for both the 1st operator r = 0.99 and the 2nd r = 0.936. The inter-operator reliability was also very reliable both at the first control r = 0.980 and at the second r = 0.961.


The results confirm that the BHOHB give results comparable to those obtained with radiography and these results are not influenced by the operator.


We can affirm that even today the ST can be useful in the diagnosis and treatment of scoliosis, but the advice is to use it above all to evaluate the evolution of the curves, in this way it is possible to reduce the exposure of patients to X-rays

Disclosures (any Conflicts of Interest)
I have no conflict of interest.

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