Scoliosis classifications Adopted for Non operative Treatment. Manuel D. Rigo MD PhD Institut Elena Salvá Barcelona

Transcription

1 Scoliosis classifications Adopted for Non operative Treatment Manuel D. Rigo MD PhD Institut Elena Salvá Barcelona

2 Disclosure: Medical director of Institut Elena Salvá. Private rehabilitation clinic Medical advisor of Ortholutions Manuel D. Rigo MD PhD Institut Elena Salvá Barcelona

3 THE JOURNAL OF BONE AND JOINT SURGERY. JBJS. ORG VOLUME 83-A. NUMBER 8. AUGUST 2001 (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

4 Lenke classification of AIS is used to determine the appropriate vertebral levels to be included in an arthrodesis

5 Lenke Classification to define Non LIMITATIONS Operative treatment? Reliable but too complex for that purpose and questionable in mild scoliosis

6 Lenke Classification to define Non LIMITATIONS Operative treatment? Structural curves (definition) residual coronal curve on side bending radiographs of at least 25º (PT, MT, TL, L) >20º of kyphosis in its specific region

7 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)

8 Ponseti (I.V.) Friedman (B.). Prognosis in idiopathic scoliosis. J. Bone Jt. Surg., 1950, 32 A, Lumbar Thoracolumbar Thoracic Double Apex Th11 12 J.I.P James (Edinburgh) Scoliosis 1967 S. Livingstone Ltd P Stagnara (Lyon) Les déformations du rachis Masson S.A. Deformaciones del raquis 1987

9 Scoliosis Research Society Definitions 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 Single Composite 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) Modified SRS Terminology Major lumbar or TL / Minor Thoracic (Rigo) Double major = 2 structural curves with a Cobb angle not 5º 10

11 An unique classification adopted for Non Operative treatment? Different brace (and physiotherapy) concepts and principles

12 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 :4) Dynamic Derotation Brace (scoliosis :20) Chêneau type and derivates ( scoliosis :1) Progressive Action Short Brace PASB (scoliosis :6) Some brace concepts use curve use other criteria than curve pattern on brace design: Boston (Published Blueprints) SPoRT (scoliosis :8)

13 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

14 34º 48º 55º R0 R1+ 7º 10º R0 R5

15 Rigo M et al: A specific scoliosis classification correlating with brace treatment: description and reliability. Scoliosis :1 (Revision ready for submission)

16 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 rediscussed

17 Conclusions Following the specific principles, classification and blueprints for any particular brace and physiotherapy concept is essential for success

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