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.
Highlights
The first proposed classification for scoliosis was based on the localization of the curves according to the curve’s apex vertebra, and has been initially developed by Schulthess [1]
The main purpose of this systematic review is to identify all the three dimensional classification systems proposed until now in the scientific literature with the aim to identify the most simple to use in the everyday clinical activity and eventually develop and propose with further studies a new classification system. Materials and methods This is a systematic review of all the studies presenting a three dimensional classification of scoliosis during growth published in the literature until now
The literature was reviewed in reference to 3D scoliosis classification systems for adolescent idiopathic scoliosis
Summary
The first proposed classification for scoliosis was based on the localization of the curves according to the curve’s apex vertebra, and has been initially developed by Schulthess [1]. Ponseti and Friedman revised this classification, with the approval of the Scoliosis Research Society committee [2]. They divided cases into singlecurve, double-curve, and triple-curve patterns. The bi-dimensionality of this widely used classification can represent a great limit if we consider the new developed technologies. Considering that scoliosis is a three dimensional deformity, a three dimensional clinical and diagnostic approach is preferable. These new measures, concerning the third dimension, can hide important risk factors. SRS 3D Scoliosis Committee has recognized the need to develop a valid and clinically useful 3D classification of AIS
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