Development and initial validation of classification for severe spinal deformity based on X-ray features

Area of Science:

• Orthopedics
• Radiology
• Spine Surgery

Background:

• Severe spinal deformities require accurate classification for effective treatment.
• Existing classification systems may lack comprehensive X-ray based criteria.
• Clinical feasibility and reliability are crucial for surgical planning.

Purpose of the Study:

• To develop a clinically feasible classification system for severe spinal deformities.
• To base the classification on objective X-ray features.
• To assess the reliability of the proposed classification system.

Main Methods:

• A retrospective analysis of 223 severe spinal deformity cases undergoing corrective surgery.
• Development of a novel classification based on three components: curve types, curve angle, and apex location.
• Evaluation of inter-observer and intra-observer reliability using kappa values.

Main Results:

• The classification included five curve types: single scoliosis (SS), kyphoscoliosis (KS), angular deformity (AD), long curve (LC), and double curves (DC).
• Curve angles were graded (A-D) on coronal and sagittal planes, with specific case distributions.
• Apex locations were precisely identified by vertebral level, showing varied distributions.
• High inter-observer and intra-observer reliability (kappa > 0.80) was achieved for all components.

Conclusions:

• A novel, reliable X-ray based classification for severe spinal deformity has been established.
• The classification demonstrates high inter-observer and intra-observer reliability.
• This system provides a standardized approach to aid in clinical decision-making and prognostic prediction for spinal deformities.