This Article Full Text Full Text (PDF) [Supplementary Material] Letters to the Editor: Submit a response Letters to the Editor: View responses Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lenke, L. G. Articles by Blanke, K. Search for Related Content PubMed PubMed Citation Articles by Lenke, L. G. Articles by Blanke, K. Social Bookmarking                   What's this?

Adolescent Idiopathic Scoliosis

A New Classification to Determine Extent of Spinal Arthrodesis

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.

CiteULike    Connotea    Del.icio.us    Facebook    Technorati    Twitter    What's this?

This article has been cited by other articles:

				E. Cuartas, A. Rasouli, M. O'Brien, and H. L. Shufflebarger Use of All-pedicle-screw Constructs in the Treatment of Adolescent Idiopathic Scoliosis J. Am. Acad. Ortho. Surg., September 1, 2009; 17(9): 550 - 561. [Abstract] [Full Text] [PDF]

				P. O. Newton, V. V. Upasani, J. Lhamby, V. L. Ugrinow, J. B. Pawelek, and T. P. Bastrom Surgical Treatment of Main Thoracic Scoliosis with Thoracoscopic Anterior Instrumentation. A Five-Year Follow-up Study J. Bone Joint Surg. Am., October 1, 2008; 90(10): 2077 - 2089. [Abstract] [Full Text] [PDF]

				J. O. Sanders, J. G. Khoury, S. Kishan, R. H. Browne, J. F. Mooney III, K. D. Arnold, S. J. McConnell, J. A. Bauman, and D. N. Finegold Predicting Scoliosis Progression from Skeletal Maturity: A Simplified Classification During Adolescence J. Bone Joint Surg. Am., March 1, 2008; 90(3): 540 - 553. [Abstract] [Full Text] [PDF]

				L. Y. Carreon, R. M. Puno, L. G. Lenke, B. S. Richards, D. J. Sucato, J. B. Emans, and M. A. Erickson Non-Neurologic Complications Following Surgery for Adolescent Idiopathic Scoliosis J. Bone Joint Surg. Am., November 1, 2007; 89(11): 2427 - 2432. [Abstract] [Full Text] [PDF]

				L. G. Lenke and M. B. Dobbs Management of Juvenile Idiopathic Scoliosis J. Bone Joint Surg. Am., February 1, 2007; 89(suppl_1): 55 - 63. [Full Text] [PDF]

				J. O. Sanders, R. H. Browne, S. J. McConnell, S. A. Margraf, T. E. Cooney, and D. N. Finegold Maturity Assessment and Curve Progression in Girls with Idiopathic Scoliosis J. Bone Joint Surg. Am., January 1, 2007; 89(1): 64 - 73. [Abstract] [Full Text] [PDF]

				S. V. Braun, D. M. Hedden, and A. W. Howard Superior Mesenteric Artery Syndrome Following Spinal Deformity Correction J. Bone Joint Surg. Am., October 1, 2006; 88(10): 2252 - 2257. [Abstract] [Full Text] [PDF]

				D. G. Stewart Jr and D. L. Skaggs Consultation with the specialist: adolescent idiopathic scoliosis. Pediatr. Rev., August 1, 2006; 27(8): 299 - 306. [Full Text] [PDF]

				B. S. Lonner, D. Kondrachov, F. Siddiqi, V. Hayes, and C. Scharf Thoracoscopic Spinal Fusion Compared with Posterior Spinal Fusion for the Treatment of Thoracic Adolescent Idiopathic Scoliosis J. Bone Joint Surg. Am., May 1, 2006; 88(5): 1022 - 1034. [Abstract] [Full Text] [PDF]

				R. M. Schwend Pulmonary Dysfunction in Adolescents with Scoliosis AAP Grand Rounds, March 1, 2006; 15(3): 28 - 29. [Full Text] [PDF]

				P. O. Newton, F. D. Faro, S. Gollogly, R. R. Betz, L. G. Lenke, and T. G. Lowe Results of Preoperative Pulmonary Function Testing of Adolescents with Idiopathic Scoliosis. A Study of Six Hundred and Thirty-one Patients J. Bone Joint Surg. Am., September 1, 2005; 87(9): 1937 - 1946. [Abstract] [Full Text] [PDF]

				Y. J. Kim, L. G. Lenke, K. H. Bridwell, K. L. Kim, and K. Steger-May Pulmonary Function in Adolescent Idiopathic Scoliosis Relative to the Surgical Procedure J. Bone Joint Surg. Am., July 1, 2005; 87(7): 1534 - 1541. [Abstract] [Full Text] [PDF]

				D. J. Sucato Thoracoscopic Anterior Instrumentation and Fusion for Idiopathic Scoliosis J. Am. Acad. Ortho. Surg., July 1, 2003; 11(4): 221 - 227. [Abstract] [Full Text] [PDF]

				J. F. Sarwark What's New in Pediatric Orthopaedics J. Bone Joint Surg. Am., May 1, 2003; 85(5): 976 - 981. [Full Text] [PDF]

Letters to the Editor:

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2001 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.