Skip to main content

Evaluation of a new sagittal classification system in adolescent idiopathic scoliosis

A Correction to this article was published on 28 January 2020

This article has been updated

Abstract

Purpose

The purpose of the present study was to validate a new spinal sagittal classification.

Methods

We retrospectively included 105 consecutive AIS patients who underwent posterior spinal fusion. Preoperative long-standing EOS radiographs were available on all patients. Patients were classified according to the four suggested sagittal patterns: type 1, 2a, 2b or 3. Several predetermined sagittal parameters were compared between the groups.

Results

The mean preoperative Cobb angle was 64° ± 12°, and 73% of the patients were female. Of 105 patients, 51 were type 1, 14 were type 2a, one was type 2b and 39 were type 3. The distribution of the four sagittal patterns was significantly different compared with the original publication (p < 0.05). However, the two study populations were comparable in terms of Lenke and Roussouly types (p = 0.49 and 0.47, respectively). In our study population, the sagittal groups differed significantly in terms of thoracic kyphosis, length of thoracic and lumbar curves, lumbar lordosis, thoracic slope, C7 slope, pelvic incidence and sacral slope (p < 0.05).

Conclusion

The distribution of the four sagittal patterns varies between AIS cohorts. Type 2b was rare, which limits the clinical applicability. Contrary to the original publication, we found that the spinopelvic parameters lumbar lordosis, pelvic incidence and sacral slope were significantly different between the Abelin-Genevois types. Hence, the corrective surgical strategy may need to incorporate these spinopelvic parameters to achieve a balanced spine requiring a minimum of energy expenditure.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Change history

  • 28 January 2020

    Unfortunately, the names of the members of the Texas Children’s Hospital Spine Study Group have not been mentioned in the published article.

References

  1. Glassman SD, Berven S, Bridwell K et al (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 30:682–688

    Article  Google Scholar 

  2. Faundez A, Hoffmeyer P, Aunoble S et al (2014) Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. Int Orthop 39:87–95. https://doi.org/10.1007/s00264-014-2516-6

    Article  PubMed  Google Scholar 

  3. Bhagat S, Vozar V, Lutchman L et al (2013) Morbidity and mortality in adult spinal deformity surgery: Norwich Spinal Unit experience. Eur Spine J 22:42–46. https://doi.org/10.1007/s00586-012-2627-y

    Article  PubMed Central  Google Scholar 

  4. de Jonge T, Dubousset JF, Illés T (2002) Sagittal plane correction in idiopathic scoliosis. Spine (Phila Pa 1976) 27:754–760

    Article  Google Scholar 

  5. Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis. J Bone Jt Surg Am 83:1169–1181. https://doi.org/10.2106/00004623-200108000-00006

    CAS  Article  Google Scholar 

  6. Abelin-Genevois K, Sassi D, Verdun S, Roussouly P (2018) Sagittal classification in adolescent idiopathic scoliosis: original description and therapeutic implications. Eur Spine J. https://doi.org/10.1007/s00586-018-5613-1

    Article  PubMed  Google Scholar 

  7. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 30:346–353

    Article  Google Scholar 

  8. Roussouly P, Nnadi C (2010) Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 19:1824–1836. https://doi.org/10.1007/s00586-010-1476-9

    Article  PubMed  PubMed Central  Google Scholar 

  9. O’Brien MFO, Kuklo TR (2004) Radiographic measurement manual Editors in Chief

  10. Ohrt-Nissen S, Hallager DW, Karbo T et al (2017) Radiographic and functional outcome in adolescent idiopathic scoliosis operated with hook/hybrid versus all-pedicle screw instrumentation—a retrospective study in 149 patients. Spine Deform 5:401–408. https://doi.org/10.1016/j.jspd.2017.05.002

    Article  PubMed  Google Scholar 

  11. Post M, Verdun S, Roussouly P, Abelin-Genevois K (2018) New sagittal classification of AIS: validation by 3D characterization. Eur Spine J. https://doi.org/10.1007/s00586-018-5819-2

    Article  PubMed  Google Scholar 

  12. Lee CS, Lee D-H, Hwang CJ et al (2017) Cervical sagittal alignment in patients with adolescent idiopathic scoliosis: is it corrected by surgery? J Neurosurg Pediatr 21:292–301. https://doi.org/10.3171/2017.8.peds17357

    Article  PubMed  Google Scholar 

  13. Roussouly P, Labelle H, Rouissi J, Bodin A (2013) Pre- and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults. Eur Spine J. https://doi.org/10.1007/s00586-012-2571-x

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pepke W, Almansour H, Lafage R et al (2019) Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients. BMC Surg 19:1–12. https://doi.org/10.1186/s12893-019-0471-2

    Article  Google Scholar 

  15. Grob D, Frauenfelder H, Mannion AF (2007) The association between cervical spine curvature and neck pain. Eur Spine J 16:669–678. https://doi.org/10.1007/s00586-006-0254-1

    CAS  Article  PubMed  Google Scholar 

  16. Jeon WK, Kang SS, Youn MS et al (2016) Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis. Eur Spine J 25:3114–3119. https://doi.org/10.1007/s00586-016-4488-2

    Article  PubMed  Google Scholar 

  17. Ilharreborde B, Vidal C, Skalli W, Mazda K (2013) Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis treated by posteromedial translation. Eur Spine J 22:330–337. https://doi.org/10.1007/s00586-012-2493-7

    Article  PubMed  Google Scholar 

  18. Canavese F, Turcot K, De Rosa V et al (2011) Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis. Eur Spine J 20:1141–1148. https://doi.org/10.1007/s00586-011-1837-z

    Article  PubMed  PubMed Central  Google Scholar 

  19. La Maida GA, Zottarelli L, Mineo GV, Misaggi B (2013) Sagittal balance in adolescent idiopathic scoliosis: radiographic study of spino-pelvic compensation after surgery. Eur Spine J 22(Suppl 6):S859–S867. https://doi.org/10.1007/s00586-013-3018-8

    Article  PubMed  Google Scholar 

  20. Mac-Thiong JM, Labelle H, Berthonnaud E et al (2007) Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J 16:227–234. https://doi.org/10.1007/s00586-005-0013-8

    Article  PubMed  Google Scholar 

  21. Pasha S, Aubin C-E, Sangole AP et al (2014) Three-dimensional spinopelvic relative alignment in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 39:564–570. https://doi.org/10.1097/BRS.0000000000000193

    Article  Google Scholar 

  22. Betz RR, Labelle H, Mac-Thiong J-M et al (2004) Sagittal alignment of the spine and pelvis during growth. Spine (Phila Pa 1976) 29:1642–1647. https://doi.org/10.1097/01.brs.0000132312.78469.7b

    Article  Google Scholar 

  23. Lonner BS, Auerbach JD, Sponseller P et al (2010) Variations in pelvic and other sagittal spinal parameters as a function of race in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 35:374–377. https://doi.org/10.1097/BRS.0b013e3181bb4f96

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Sidsel Fruergaard.

Ethics declarations

Conflict of interest

B. Dahl and M. Gehrchen have received institutional grants from K2M and Medtronic. J. Heydemann is a comitee member of POSNA, AACPDM and SRS and shareholder in Merck, Sanofi Avanti and Orthopediatrics, unrelated to this work. L. Deveza is a shareholder in Lento Medical Inc. and has received research funding from OREF (Orthopedic Research an Education Fund), unrelated to this work. C. Dragsted, S. Ohrt-Nissen, M. Jain, D. Liu and S. Fruergaard have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 366 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fruergaard, S., Jain, M.J., Deveza, L. et al. Evaluation of a new sagittal classification system in adolescent idiopathic scoliosis. Eur Spine J 29, 744–753 (2020). https://doi.org/10.1007/s00586-019-06241-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-019-06241-5

Keywords

  • Adolescent idiopathic scoliosis
  • Classification
  • Hypokyphosis
  • Sagittal alignment
  • Treatment guidelines
  • Validation