Geometric Torsion in Adolescent Idiopathic Scoliosis: A New Method to Differentiate Between Lenke 1 Subtypes.

ABSTRACT

STUDY DESIGN: Consecutive case series. OBJECTIVE: To study geometric torsion in thoracic adolescent idiopathic scoliosis (AIS) to propose it as a numerical three-dimensional (3D) parameter that quantifies the scoliosis deformity. SUMMARY OF BACKGROUND DATA AIS is a 3D deformity of the spine. The most widely accepted and used classification systems, however, still rely on two-dimensional aspects of x-rays. Yet, a 3D classification of AIS remains elusive because there is no widely accepted 3D parameter in the clinical practice. METHODS: Analysis of 141 patients with Lenke type-1 deformity recruited in our institution. The Lenke classification was identified by two observers and 3D reconstructions were obtained using biplanar radiographs. Geometric torsion measuring the twisting effect of the spine was computed using a novel technique by approximating local arc lengths at the neutral vertebra in the thoracolumbar segment. An inter- and intragroup statistical analysis was performed to evaluate the torsion index, and how it relates to other 3D indices. RESULTS: A statistically significant increase in torsion was observed between Lenke 1A (1.15 mm) and Lenke 1C (2.10 mm) subgroups. No differences were found between the Lenke 1B (1.75 mm) subgroup with either of the other two subgroups. An automatic classification based on torsion indices identified two groups one with high torsion values (3.02 mm) and one with low torsion values (0.82 mm). Statistically significant differences were found between the main thoracic planes of maximum curvature (PMC) orientation of the high-torsion group (73.72°) and the low-torsion group (79.85°). Statistically significant differences were also found for the thoracolumbar/lumbar PMC orientation between the high-torsion group (56.41°) and the low-torsion group (49.25°). CONCLUSION: These results suggest that a numerical method of describing scoliosis in 3D is within reach. They also suggest the existence of two subgroups of 3D deformations based on torsion values (high and low) with links to PMC orientation. LEVEL OF EVIDENCE 4.