The reliability of the augmented Lehnert-Schroth and Rigo classification in scoliosis management.

Burçin Akçay,Tuğba Kuru Çolak,İlker Çolak,Adnan Apti,Önder Kızıltaş

doi:10.4102/sajp.v77i2.1568

Abstract

BackgroundIn pattern-specific scoliosis exercises and bracing, the corrective treatment plan differs according to different curve patterns. There are a limited number of studies investigating the reliability of the commonly used classifications systems.ObjectiveTo test the reliability of the augmented Lehnert-Schroth (ALS) classification and the Rigo classification.MethodsX-rays and posterior photographs of 45 patients with scoliosis were sent by the first author to three clinicians twice at 1-week intervals. The clinicians classified images according to the ALS and Rigo classifications, and the data were analysed using SPSS V-16. Intraclass correlation coefficients (ICCs) and standard error measurement (SEM) were calculated to evaluate the inter- and intra-observer reliability.ResultsThe inter-observer ICC values were 0.552 (ALS), 0.452 (Rigo) for X-ray images and 0.494 (ALS), 0.518 (Rigo) for the photographs. The average intra-observer ICC value was 0.720 (ALS), 0.581 (Rigo) for the X-ray images and 0.726 (ALS) and 0.467 (Rigo) for the photographs.ConclusionsThe results of our study indicate moderate inter-observer reliability for X-ray images using the ALS classification and clinical photographs using the Rigo classification. Intra-observer reliability was moderate to good for X-ray images and clinical photographs using the ALS classification and poor to moderate for X-ray and clinical photographs using the Rigo classification.Clinical implicationsPattern classifications assist in creating a plan and indication of correction in specific scoliosis physiotherapy and pattern-specific brace applications and surgical treatment. More sub-types are needed to address the individual patterns of curvature. The optimisation of curve classification will likely reduce failures in diagnosis and treatment.

Highlights

Scoliosis is a three-dimensional deformity of the spine and trunk, including lateral flexion and rotation of the vertebrae with sagittal plane changes
The results of our study indicate moderate inter-observer reliability for X-ray images using the augmented Lehnert-Schroth (ALS) classification and clinical photographs using the Rigo classification
Intraobserver reliability was moderate to good for X-ray images and clinical photographs using the ALS classification and poor to moderate for X-ray and clinical photographs using the Rigo classification

Summary

Introduction

Scoliosis is a three-dimensional deformity of the spine and trunk, including lateral flexion and rotation of the vertebrae with sagittal plane changes. Current management strategies for idiopathic scoliosis include observation, physiotherapy that includes scoliosis-specific exercises, bracing, and surgery (Bettany-Saltikov et al 2014; Horne et al 2014; Moramarco et al 2020). For ease of treatment approaches and to address the biomechanical properties and planning of correction, several curve classification systems have been developed for exercise, brace, and surgical treatments. In the late 1970s, a simple, functional classification for approaching different curve patterns with physiotherapy was established by Lehnert-Schroth (2007). In pattern-specific scoliosis exercises and bracing, the corrective treatment plan differs according to different curve patterns. There are a limited number of studies investigating the reliability of the commonly used classifications systems

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Discussion

Conclusion