Abstract
BackgroundSpinal classification systems for scoliosis which were developed to correlate with surgical treatment historically have been used in brace treatment as well. Previously, there had not been a scoliosis classification system developed specifically to correlate with brace design and treatment. The purpose of this study is to show the intra- and inter- observer reliability of a new scoliosis classification system correlating with brace treatment.MethodsAn original classification system ("Rigo Classification") was developed in order to define specific principles of correction required for efficacious brace design and fabrication. The classification includes radiological as well as clinical criteria. The radiological criteria are utilized to differentiate five basic types of curvatures including: (I) imbalanced thoracic (or three curves pattern), (II) true double (or four curve pattern), (III) balanced thoracic and false double (non 3 non 4), (IV) single lumbar and (V) single thoracolumbar. In addition to the radiological criteria, the Rigo Classification incorporates the curve pattern according to SRS terminology, the balance/imbalance at the transitional point, and L4-5 counter-tilting. To test the intra-and inter-observer reliability of the Rigo Classification, three observers (1 MD, 1 PT and 1 CPO) measured (and one of them, the MD, re-measured) 51 AP radiographs including all curvature types.ResultsThe intra-observer Kappa value was 0.87 (acceptance >0.70). The inter-observer Kappa values fluctuated from 0.61 to 0.81 with an average of 0.71 (acceptance > 0.70).ConclusionsA specific scoliosis classification which correlates with brace treatment has been proposed with an acceptable intra-and inter-observer reliability.
Highlights
Spinal classification systems for scoliosis which were developed to correlate with surgical treatment historically have been used in brace treatment as well
The terms and diagnosis criteria defined by Lehnert-Schroth appeared simple but, were, more sophisticated than a mere classification of single and double. She used the terms ‘three curve pattern’ and ‘four curve pattern’ to differentiate between single thoracic with no lumbar or with a minor lumbar curve (’three curves scoliosis pattern’) from a true double curve associated with a compensatory-lumbosacral curve (’four curve scoliosis pattern’)
The Kappa value in the intraobserver test was 0.87. Both inter- and intra-observer mean Kappa values were over the acceptance value of 0.70
Summary
Spinal classification systems for scoliosis which were developed to correlate with surgical treatment historically have been used in brace treatment as well. The Providence brace system proposes three basic models: lumbar, thoracolumbar and double curve brace designs, with an extension available for high thoracic curves This simplified approach had been used previously by Lehnert-Schroth [16] to differentiate two functional types of curves in physical therapy, for which she developed the nomenclature ‘three curves scoliosis pattern’ and ‘four curves scoliosis pattern’. The terms and diagnosis criteria defined by Lehnert-Schroth appeared simple but, were, more sophisticated than a mere classification of single and double She used the terms ‘three curve pattern’ and ‘four curve pattern’ to differentiate between single thoracic with no lumbar or with a minor lumbar curve (’three curves scoliosis pattern’) from a true double curve associated with a compensatory-lumbosacral curve (’four curve scoliosis pattern’). Chêneau initially defined ‘three curve scoliosis’ as any single curve and ‘four curve scoliosis’ as any double curve; correspondingly, he proposed two basic brace designs called ‘three curve scoliosis brace’ and ‘four curve scoliosis brace’
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