A Decision Tree Can Increase Accuracy When Assessing Curve Types According to Lenke Classification of Adolescent Idiopathic Scoliosis

AbstractAim of the study was to evaluate sagittal parameters modifications, with particular interest in thoracic kyphosis, in patients affected by adolescent idiopathic scoliosis (AIS) comparing hybrid and all-screws technique. From June 2010 to September 2018, 145 patients were enrolled. Evaluation included: Lenke classification, Risser scale, coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Patients were divided in two groups (1 all-screws and 2 hybrid); a further division, in both groups, was done considering preoperative TK values. Descriptive and inferential statistical analysis was conducted. 99 patients were in group 1, 46 in group 2 (mean follow-up 3.7 years). Patients with a normo-kyphotic profile developed a little variation in TK (Δ pre–post = 2.4° versus − 2.0° respectively). Hyper-kyphotic subgroups had a tendency of restoring a good sagittal alignment. Hypo-kyphotic subgroups, patients treated with all-screw implants developed a higher increase in TK mean Cobb angle (Δ pre–post = 10°) than the hybrid subgroup (Δ pre–post = 5.4°) (p = 0.01). All-screws group showed better results in restoring sagittal alignment in all subgroups compared to hybrid groups, especially in hypo-TK subgroup, with the important advantage to give better correction on coronal plane.

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What happens to the unfused upper thoracic curve after posterior spinal fusion for adolescent idiopathic scoliosis?

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.10.peds20671 ◽

2021 ◽

pp. 1-7

Author(s):

M. Omar Iqbal ◽

Amer F. Samdani ◽

Joshua M. Pahys ◽

Peter O. Newton ◽

Suken A. Shah ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Univariate Analysis ◽

Posterior Spinal Fusion ◽

Research Society ◽

Curve Correction ◽

Scoliosis Research Society ◽

Lenke Classification ◽

Upper Instrumented Vertebra ◽

Upper Thoracic

OBJECTIVE Spontaneous lumbar curve correction after selective thoracic fusion in surgery for adolescent idiopathic scoliosis (AIS) is well described. However, only a few articles have described the course of the uninstrumented upper thoracic (UT) curve after fusion, and the majority involve a hybrid construct. In this study, the authors sought to determine the outcomes and associated factors of uninstrumented UT curves in patients with AIS. METHODS The authors retrospectively reviewed a prospectively collected multicenter AIS registry for all consecutive patients with Lenke type 1–4 curves with a 2-year minimum follow-up. UT curves were considered uninstrumented if the upper instrumented vertebra (UIV) did not extend above 1 level from the lower end vertebra of the UT curve. The authors defined progression as > 5°, and divided patients into two cohorts: those with improvement in the UT curve (IMP) and those without improvement in the UT curve (NO IMP). Radiographic, demographic, and Scoliosis Research Society (SRS)–22 survey outcome measures were compared using univariate analysis, and significant factors were compared using a multivariate regression model. RESULTS The study included 450 patients (370 females and 80 males). The UT curve self-corrected in 86% of patients (n = 385), there was no change in 14% (n = 65), and no patients worsened. Preoperatively, patients were similar with respect to Lenke classification (p = 0.44), age (p = 0.31), sex (p = 0.85), and Risser score (p = 0.14). The UT curves in the IMP group self-corrected from 24.7° ± 6.5° to 12.6° ± 5.9°, whereas in the NO IMP group UT curves remained the same, from 20.3° ± 5.8° to 18.5° ± 5.7°. In a multivariate analysis, preoperative main thoracic (MT) curve size (p = 0.004) and MT curve correction (p = 0.001) remained significant predictors of UT curve improvement. Greater correction of the MT curve and larger initial MT curve size were associated with greater likelihood of UT curve improvement. CONCLUSIONS Spontaneous UT curve correction occurred in the majority (86%) of unfused UT curves after MT curve correction in Lenke 1–4 curve types. The magnitude of preoperative MT curve size and postoperative MT curve correction were independent predictors of spontaneous UT curve correction.

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Classification of Thoracic Adolescent Idiopathic Scoliosis

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200006000-00026 ◽

2000 ◽

Vol 82 (6) ◽

pp. 901

Author(s):

Angel M. Hidalgo-Ovejero ◽

Serafín García-Mata ◽

Manuel Martinez-Grande ◽

Tomás Izco-Cabezón

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis

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Interobserver Reliability and Intraobserver Reproducibility of the System of King et al. for the Classification of Adolescent Idiopathic Scoliosis*

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-199808000-00003 ◽

1998 ◽

Vol 80 (8) ◽

pp. 1107-11 ◽

Cited By ~ 98

Author(s):

R. JAY CUMMINGS ◽

ERIC A. LOVELESS ◽

JOSEPH CAMPBELL ◽

STEPHEN SAMELSON ◽

JOHN M. MAZUR

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Interobserver Reliability ◽

Intraobserver Reproducibility

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Choosing the Distal Fusion Levels in Lenke Type 1 Adolescent Idiopathic Scoliosis: How Do the Existing Classifications and Recommendations Guide Us?

Global Spine Journal ◽

10.1177/2192568220910712 ◽

2020 ◽

pp. 219256822091071

Author(s):

Bhavuk Garg ◽

Nishank Mehta ◽

Rudra Narayan Mukherjee

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Treatment Outcomes ◽

Outcome Measures ◽

Deformity Correction ◽

Sagittal Vertical Axis ◽

Scoliosis Research Society ◽

Lenke Classification ◽

Selective Fusion ◽

Significant Difference

Study Design: Retrospective cohort. Objective: ( a) To compare the recommendations of Lenke and Peking Union Medical College (PUMC) classifications in choosing distal fusion levels in Lenke 1 adolescent idiopathic scoliosis (AIS) curves and ( b) to analyze whether the variability in distal fusion levels influences treatment outcomes. Methods: Hospital records of Lenke 1 AIS patients operated for single stage, posterior-only deformity correction were analyzed. Distal fusion levels recommended by Lenke and PUMC classifications were calculated and were compared with the actual distal fusion levels. The study population was divided based on whether the actual distal fusion levels were in agreement, shorter or longer than those recommended by Lenke classification. Subgroup analysis of Lenke 1C curves was done. The groups were compared with regard to the following outcome measures: Cobb angle correction, postoperative sagittal vertical axis, postoperative C7 offset, and Scoliosis Research Society–22r (SRS-22r) score at 24 months. Results: The distal fusion levels recommended by the 2 classifications were in agreement in 92 of 104 cases. In all the cases with disparity, Lenke classification recommended shorter fusions than the PUMC classification. No statistically significant difference was observed in the outcome measures—whether the actual distal fusion levels were in agreement, shorter, or longer than those recommended by the Lenke classification or whether or not the recommendations for selective fusion of any of these classifications were adhered to. Conclusion: Lenke classification can save fusion levels without compromising on treatment outcomes when compared with PUMC classification. Variability in choice of distal fusion levels is not clinically significant at 24-month follow-up.

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