Did the Lenke Classification Change Scoliosis Treatment?

Abstract

The introduction of this system has led to a reduction in the variation of treatment approaches; however, our data suggest that 6% to 29% of the time, depending on the curve pattern, there are other aspects of the clinical and radiographic deformity that suggest deviation from the recommendations of the classification system. The outcome of adherence to this system remains yet to be evaluated.

Results of Selective Thoracic Versus Nonselective Fusion in Lenke Type 3 Curves

“…2 However, deviation from the recommendations has been observed in 6% to 29% of the operated cases depending on the curve type. 3 Selective fusion of the thoracic curve is performed to spare the motion segments in the lumbar spine, prevent increased intervertebral motion distal to the fusion, and decrease operative time. 3 Selective fusion of the thoracic curve is performed to spare the motion segments in the lumbar spine, prevent increased intervertebral motion distal to the fusion, and decrease operative time.…”

A rule-based algorithm can output valid surgical strategies in the treatment of AIS

“…Surgical strategies were better matched for simple curve types as opposed to complex ones for which less surgical strategies were proposed and for which the literature is less extensive. The development of SSRBAs able to output surgical strategy alternatives should allow the comparisons of various strategies and their outcomes for a given case and guide treatment for those cases that do not fit in typical curve types [58,60,61]. …”

“…It is important to highlight that this study used a one-level leeway to accept a surgeon strategy as similar to one of the outputs from the SSRBA. Most studies compare the inclusion or exclusion of each of the curves when comparing strategies [60][61][62]. This level of accuracy in determining the surgical strategy was wished by the author to use the rules which are usually based on specific vertebras as precisely as possible.…”

Decision Making Algorithm for Adult Spinal Deformity Surgery

“…Advantages of Lenke classification are; 85–90% predictability, thoracolumbar/lumbar curves included, triple curve (Lenke type 4) defined, and 2-dimensional (coronal and sagittal plane) classification. However, several limitations have been recognized as follows : 12% rule breaker 4) , no selective fusion criteria included, poor inter-observer reliability in proximal thoracic curve, 2-dimensional (not 3-dimensional), no lowest or uppermost instrumented vertebra (UIV) criteria included. Using by Lenke classification, LIV is usually located in the middle of the curve for 3 or 4 curve A or B lumbar modifier.…”