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Classification of Lenke et al for Adolescent Idiopathic Scoliosis: Lumbar Spine Modifier Rules

Description

Lenke et al reported a classification for adolescent idiopathic scoliosis. This included rules for placing modifiers based on the appearance of the lumbar spine in X-rays. The authors are from Barnes-Jewish Hospital and Washington University in St. Louis.


Study: upright coronal radiograph of the lumbar spine

 

Study exclusion: pelvic tilt > 2 cm. If present, then use blocks under the lower leg to level the pelvis.

 

Analysis:

(1) Draw the center sacral vertical line (CSVL), a vertical line bisecting the proximal sacrum.

(2) Identify the "stable" vertebra: The most proximal (cepahalad) lower thoracic or lumbar vertebra most closely bissected by the CSVL. If a disc is most closely bisected, then select the adjacent caudad vertebra as stable.

 

Scoliosis Research Society Curve Definition

Apex

thoracic curve

T2 to disc for T11-T12

thoracolumbar curve

T12 to L1

lumbar curve

disc for L1-L2 to L4

 

 

CSVL

Apex

Modifier

falls between lumbar pedicles up to the "stable" vertebra

thoracic

A

falls between medial border of lumbar concave pedicle and lateral margin of apical vertebral body (or bodies if apex is a disc).

thoracic

B

medial to lateral aspect of lumbar apical vertebral body (or bodies if apex is a disc).

thoracic, thoracolumbar, and/or lumbar

C

 


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