The comprehensive anatomical spinal osteotomy classification.

Published

Journal Article

BACKGROUND: Global sagittal malalignment is significantly correlated with health-related quality-of-life scores in the setting of spinal deformity. In order to address rigid deformity patterns, the use of spinal osteotomies has seen a substantial increase. Unfortunately, variations of established techniques and hybrid combinations of osteotomies have made comparisons of outcomes difficult. OBJECTIVE: To propose a classification system of anatomically-based spinal osteotomies and provide a common language among spine specialists. METHODS: The proposed classification system is based on 6 anatomic grades of resection (1 through 6) corresponding to the extent of bone resection and increasing degree of destabilizing potential. In addition, a surgical approach modifier is added (posterior approach or combined anterior and posterior approaches). Reliability of the classification system was evaluated by an analysis of 16 clinical cases, rated 2 times by 8 different readers, and calculation of Fleiss kappa coefficients. RESULTS: Intraobserver reliability was classified as "almost perfect"; Fleiss kappa coefficient averaged 0.96 (range, 0.92-1.0) for resection type and 0.90 (0.71-1.0) for the approach modifier. Results from the interobserver reliability for the classification were 0.96 for resection type and 0.88 for the approach modifier. CONCLUSION: This proposed anatomically based classification system provides a consistent description of the various osteotomies performed in spinal deformity correction surgery. The reliability study confirmed that the classification is simple and consistent. Further development of its use will provide a common frame for osteotomy assessment and permit comparative analysis of different treatments.

Full Text

Duke Authors

Cited Authors

  • Schwab, F; Blondel, B; Chay, E; Demakakos, J; Lenke, L; Tropiano, P; Ames, C; Smith, JS; Shaffrey, CI; Glassman, S; Farcy, J-P; Lafage, V

Published Date

  • January 2014

Published In

Volume / Issue

  • 74 / 1

Start / End Page

  • 112 - 120

PubMed ID

  • 24356197

Pubmed Central ID

  • 24356197

Electronic International Standard Serial Number (EISSN)

  • 1524-4040

Digital Object Identifier (DOI)

  • 10.1227/NEU.0000000000000182o

Language

  • eng

Conference Location

  • United States