scoliosis classifications adopted for non-operative treatment
TRANSCRIPT
Scoliosis classifications Adopted for Non‐operative Treatment
Manuel D. Rigo MD PhDInstitut Elena Salvá Barcelona
Manuel D. Rigo MD PhDInstitut Elena Salvá Barcelona
Disclosure:‐Medical director of ‘Institut Elena Salvá’. Private rehabilitation clinic‐Medical advisor of ‘Ortholutions’
• (1) be comprehensive and include all types of curves• (2) emphasize consideration of sagittal alignment• (3) help to define treatment that could be standardized• (4) be based on objective criteria for each curve type• (5) have good‐to‐excellent interobserver and
intraobserver reliability• (6) be easily understood and of practical value in the
clinical setting
THE JOURNAL OF BONE AND JOINT SURGERY . JBJS. ORG VOLUME 83-A . NUMBER 8 . AUGUST 2001
Lenke classification of AIS is used to determine the appropriate vertebral levels to be included in an arthrodesis
Lenke Classification to define Non‐Operative treatment ?
LIMITATIONS
• Reliable but too complex for that purpose and questionable in mild scoliosis
Lenke Classification to define Non‐Operative treatment ?
LIMITATIONSStructural curves (definition) • residual coronal curve on side‐bending radiographs of at least 25º (PT, MT, TL, L)
• >20º of kyphosis in its specific region
Old and recent literature on Bracing and physiotherapy
• (1) Single and double• (2) Thoracic, lumbar, thoracolumbar and double (Ponseti and Friedman 1950)
• (3) 3 single and 4 combined types (Moe and Kettleson (1970)
• (4) 4 single and 4 combined types (Lee, Denis, Winter and Lonstein modification 1993)
• (5) King classification (King, Moe, Winter and Bradford, 1983)
Ponseti (I.V.) Friedman (B.).‐ Prognosis in idiopathic scoliosis. J. Bone Jt. Surg., 1950, 32‐A, 381‐395
J.I.P James (Edinburgh)Scoliosis ©1967 S. Livingstone Ltd
Lumbar Thoracolumbar Thoracic DoubleApex Th11‐12
P Stagnara (Lyon)Les déformations du rachis Masson S.A.Deformaciones del raquis ©1987
Scoliosis Research SocietyDefinitions to determine the type of curve
• Thoracic: Apex Th2‐Th11 (Disc Th11‐12)• Proximal Thoracic: Apex Th3‐4‐5• Thoracolumbar: Apex Th12‐L1 • Lumbar: Apex L2‐L4 (L1‐2 disc)
9
10
• Single Major High Thoracic(upper or proximal)
• Single Major Thoracic• Single Major Thoracolumbar• Single Major Lumbar• Major Thoracic and Minor Lumbar• Double Major Thoracic and Lumbar• Double Major Thoracic and Thoracolumbar• Double Major Thoracic• Multiple
Lonstein’s Revision of the Moe & Ketleson (1970)
• Thoracic: T2‐T11 (Disc T11‐12)• Proximal Thoracic: T3‐4‐5• Main T = High: T6‐7 Low T9‐11• Thoracolumbar: T12‐L1 • Lumbar: L2‐L4 (Disc L1‐2)• Lumbosacral: L5‐S1 (Disc L4‐5)
SingleComposite
Double major = 2 structural curves with a Cobb angle not ≠ 5º
Major lumbar or TL / Minor Thoracic(Rigo)
+
Modified SRS Terminology
An unique classification adopted for Non‐Operative treatment ?
• Different brace (and physiotherapy) concepts and principles
Some PT schools and brace concepts use curve pattern specific classifications:
• Schroth (Published in several books and papers)• SpineCor (Published Blueprints)• Providence (Published Blueprints)• Lyon brace (scoliosis 2011 6:4)• Dynamic Derotation Brace (scoliosis 2010 5:20)• Chêneau type and derivates ( scoliosis 2010 5:1)• Progressive Action Short Brace PASB (scoliosis 2012 7:6)
Some brace concepts use curve use other criteria than curve pattern on brace design:
• Boston (Published Blueprints)• SPoRT (scoliosis 2011 6:8)
Two original Chêneau designs (3 curves and 4 curves) locating at different levels the derotation PADS to form several Derotation +
Three‐point Systems according to the curve pattern
34º 48º55º
R0 R1+
R0
10º
R5
7º
Rigo M et al: A specific scoliosis classification correlating with brace treatment: description and reliability. Scoliosis 2010 5:1 (Revision ready for submission)
Conclusions
• ‘Lenke Classification’ has a limited use in Non‐Op treatment
• ‘Ponseti and Friedman’ has an explainable poor reliability
• ‘SRS terminology’ and ‘Moe& Kettleson’ could be still useful to describe population on brace and physiotherapy studies, if objective criteria are re‐discussed
Conclusions
• Following the specific principles, classification and blueprints for any particular brace and physiotherapy concept is essential for success