The Journal of Bone and Joint Surgery (American) 83:1169-1181 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Adolescent Idiopathic Scoliosis
A New Classification to Determine Extent of Spinal Arthrodesis
Lawrence G. Lenke, MD,
Randal R. Betz, MD,
Jürgen Harms, MD,
Keith H. Bridwell, MD,
David H. Clements, MD,
Thomas G. Lowe, MD and
Kathy Blanke, RN
Investigation performed at Barnes-Jewish Hospital, Washington
University, St. Louis, Missouri
Lawrence G. Lenke, MD
Keith H. Bridwell, MD
Kathy Blanke, RN
Department of Orthopaedic Surgery, Washington University School
of Medicine, One Barnes-Jewish Hospital Plaza, Suite 11300, West
Pavilion, St. Louis, MO 63100. E-mail address for L.G. Lenke: lenkel{at}msnotes.wustl.edu
Randal R. Betz, MD
Shriners Hospital for Children, Philadelphia Unit, 3551 North Broad
Street, Philadelphia, PA 19140-4131
Jürgen Harms, MD
SRH Klinikum Karlsbad-Langensteinbach, D-76307 Karlsbad, Germany
David H. Clements, MD
Temple University Hospital, 3401 North Broad Street, Philadelphia,
PA 19140
Thomas G. Lowe, MD
Woodridge Orthopaedic Clinic, 3550 Lutheran Parkway, #201,
Wheat Ridge, CO 80033-6017
In support of their research or preparation of this manuscript, one
or more of the authors received grants or outside funding from
Biedermann-Motech, Incorporated. None of the authors received payments
or other benefits or a commitment or agreement to provide such benefits
from a commercial entity. No commercial entity paid or directed,
or agreed to pay or direct, any benefits to any research fund, foundation,
educational institution, or other charitable or nonprofit organization with
which the authors are affiliated or associated.
This paper was read at the Annual Meeting of the Scoliosis Research
Society, St. Louis, Missouri, September 25, 26, and 27, 1997; was
read at the International Meeting of Advanced Spine Techniques (IMAST),
Sorrento, Italy, April 30 through May 2, 1998; and was presented
as a scientific exhibit at the Annual Meeting of the American Academy
of Orthopaedic Surgeons, Anaheim, California, February 4 through
8, 1999.
Background: The lack of a reliable, universally
acceptable system for classification of adolescent idiopathic scoliosis
has made comparisons between various types of operative treatment
an impossible task. Furthermore, long-term outcomes cannot
be determined because of the great variations in the description of
study groups.
Methods: We developed a new classification system
with three components: curve type (1 through 6), a lumbar spine
modifier (A, B, or C), and a sagittal thoracic modifier (-, N, or +).
The six curve types have specific characteristics, on coronal and
sagittal radiographs, that differentiate structural and nonstructural curves
in the proximal thoracic, main thoracic, and thoracolumbar/lumbar
regions. The lumbar spine modifier is based on the relationship
of the center sacral vertical line to the apex of the lumbar curve,
and the sagittal thoracic modifier is based on the sagittal curve
measurement from the fifth to the twelfth thoracic level. A minus
sign represents a curve of less than +10°, N represents
a curve of 10° to 40°, and a plus sign represents a curve of more
than +40°.
Five surgeons, members of the Scoliosis Research Society who
had developed the new system and who had previously tested the reliability
of the King classification on radiographs of twenty-seven
patients, measured the same radiographs (standing coronal and lateral
as well as supine side-bending views) to test the reliability of
the new classification. A randomly chosen independent group of seven
surgeons, also members of the Scoliosis Research Society, tested
the reliability and validity of the classification as well.
Results: The interobserver and intraobserver kappa
values for the curve type were, respectively, 0.92 and 0.83 for
the five developers of the system and 0.740 and 0.893 for the independent group
of seven scoliosis surgeons. In the independent group, the mean
interobserver and intraobserver kappa values were 0.800 and 0.840
for the lumbar modifier and 0.938 and 0.970 for the sagittal thoracic
modifier. These kappa values were all in the good-to-excellent range
(>0.75), except for the interobserver reliability of the
independent group for the curve type (kappa = 0.74), which
fell just below this level.
Conclusions: This new two-dimensional classification
of adolescent idiopathic scoliosis, as tested by two groups of surgeons,
was shown to be much more reliable than the King system. Additional
studies are necessary to determine the versatility, reliability,
and accuracy of the classification for defining the vertebrae to
be included in an arthrodesis.
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Letters to the Editor:
Read all Letters to the Editor
- Adolescent Idiopathic Scoliosis
- ASHRAF A ANBAR
- JBJS Online, 1 Jun 2005
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