State of the art of current 3-D scoliosis classifications: a systematic review from a clinical perspective

Abstract

Scoliosis is a complex three dimensional (3D) deformity: the current lack of a 3D classification could hide something fundamental for scoliosis prognosis and treatment. A clear picture of the actually existing 3D classifications lacks. The aim of this systematic review was to identify all the 3D classification systems proposed until now in the literature with the aim to identify similarities and differences mainly in a clinical perspective.After a MEDLINE Data Base review, done in November 2013 using the search terms “Scoliosis/classification” [Mesh] and “scoliosis/classification and Imaging, three dimensional” [Mesh], 8 papers were included with a total of 1164 scoliosis patients, 23 hyperkyphosis and 25 controls, aged between 8 and 20 years, with curves from 10° to 81° Cobb, and various curve patterns. Six studies looked at the whole 3D spine and found classificatory parameters according to planes, angles and rotations, including: Plane of Maximal Curvature (PMC), Best Fit Plane, Cobb angles in bodily plane and PMC, Axial rotation of the apical vertebra and of the PMC, and geometric 3D torsion. Two studies used the regional (spinal) Top View of the spine and found classificatory parameters according to its geometrical properties (area, direction and barycenter) including: Ratio of the frontal and the sagittal size, Phase, Directions (total, thoracic and lumbar), and Shift. It was possible to find similarities among 10 out of the 16 the sub-groups identified by different authors with different methods in different populations.In summation, the state of the art of 3D classification systems include 8 studies which showed some comparability, even though of low level. The most useful one in clinical everyday practice, is far from being defined. More than 20 years passed since the definition of the third dimension of the scoliosis deformity, now the time has come for clinicians and bioengineers to start some real clinical application, and develop means to make this approach an everyday tool.

A cluster analysis describing spine and torso shape in Lenke type 1 adolescent idiopathic scoliosis

“…Previous reports have identified a variability in the 3D shape of the torso in AIS [21]. The variability in spinal shape seen in AIS has been responsible for the development of a number Further understanding of the 3D nature of AIS combined with a desire to be able to represent this has led to the development of 3D classifications of the shape of the spine [22], most notably as the Da Vinci, or top-down, representation [6,10].…”

2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth

“…Since these guidelines concern conservative treatment, the abovementioned classification is not discussed beyond here. Moreover, efforts were made to clinically evaluate the third dimension, mainly for surgical purposes; recently, several 3D classifications have been proposed [ 74 – 82 ], but the most useful one in clinical practice is yet to be defined [ 83 ].…”

Improvement in Scoliosis Top View: Evaluation of Vertebrae Localization in Scoliotic Spine-Spine Axial Presentation

“…The measurements of central vertebral points allow one to draw the Spine Axial Projection (SAP). SAP is a projection of spinal column onto the axial plane, it is a form of "Top View" [12,14,15]. It is a presentation of vertebrae and their relations in space on axial plane.…”

“…At the "top view" the spine is presented from the cephalad side as if the observers were above the patient looking down on him. The "3D Classification Committee" of the Scoliosis Research Society (SRS) introduced two graphical presentations of the axial plane spinal deformity, the so called top views: (1) "True da Vinci Projection" and (2) "da Vinci Representation" [10][11][12]. The "True da Vinci Projection" demonstrates the position of the end-apical-end planes (EAE-planes) of the spine segments.…”